(Modified version of an article that appeared in "Open Spaces," Vol.2, #2, 1999)

Harry Stack Sullivan, the pioneer American psychiatrist, said that a psychotherapist could not really hope to understand the inner psychic world of another person, was in fact barred from doing so, because of the ultimate privacy of each individual’s thought and feeling. The best thing a therapist could do, Sullivan believed, was to understand human relationships, to witness, to describe, and to attempt to influence the transactions that occur between people. This distinction between what psychotherapy can and cannot do might also be applied to film. No film has time to give us an adequate account of the interior thoughts of people, arguably the most distinctive measure of our humanness: the rich and ever operative world of mental reflections, the "inner dialogue" of our experience, thoughts that - whether fleeting and momentary, or deeply patterned and reoccurring - define our sense of being.

However, just as therapy can effectively focus on relationships, so movies can also give us, in the most bold and intimate manner possible, the immediacy, the poignancy, of human encounters. Fine examples abound. Among American films think of Bogart and Hepburn in The African Queen - proud, fierce, contentious characters whose more appealing depths are revealed in the course of their joint struggle for survival on a jungle river; or Taylor and Burton, who revel in their acrimony in Who's Afraid of Virginia Wolfe?; Jane Fonda, Jon Voight and Bruce Dern, whose painful entanglements epitomize the tragic domestic aftermath of Vietnam in Coming Home; Sidney Poitier and Rod Steiger, personifying the incendiary quality of southern race relations during the civil rights era in In the Heat of the Night, William Hurt and his deaf pupil, Marlee Matlin, finding intimacy as they struggle to communicate in Children of a Lesser God. Or consider such wonderful imports from international cinema as Anthony Quinn and Giulietta Masina, desperate survivors in war ravaged Italy, in Fellini’s La Strada, Bibi Andersson and Liv Ullman, whose separate identities merge in Ingmar Bergman’s Persona; Jeanne Moreau, Henri Serre and Oskar Werner as a classic menage a trois in Truffaut’s Jules et Jim;or these two gems from Japan: Woman in the Dunes, Hiroshi Teshigahara's surreal meditation on human existence and domestic relations, and Shomei Imamura's The Ballad of Narayama, a riveting story of family life and social customs in a 19th century northern Japanese mountain village.

I. Emotion

One reason film succeeds so well in portraying human encounters is that film can convey emotion perhaps more powerfully than any other creative medium. Not the inner feelings of people, but emotion. E-motion, literally meaning movement outward, the outward, behavioral manifestations of inner feeling states, the social, and therefore photographable, dimension of human feeling. Some emotional expressions and gestures are candid, inadvertent, automatic even, outer signs of inner physiological processes, like Hans Selye's "fight or flight" responses to stress. Other expressions may be falsified, with or without intent, to mask or veil inner feelings and thoughts. Most are earnest yet imperfect communications that at best give us only an approximation or simplified version of the more complex inner feeling state of another person. Feeling is partly a visceral experience not easily translated into words or gestures. And human feeling is inescapably cognitive as well. Neither the psychotherapist nor the filmmaker can fully plumb the private depths of feeling. Film can, however, vividly capture emotion, and the better the actor, the more likely his or her performance will suggest the nature and complexity of inner feelings through emotional expression. (The famed Stanislavski school of "method acting" required an actor to try to become the character, so that the actor's inner feelings can inform and infect emotional gesture and kinesics.) Among others, recent demonstrations of this skill have been offered by Robert Duvall, who portrays a deeply flawed yet somehow spiritually honest charismatic preacher in his film, The Apostle; Pruitt Taylor Vince, the dependent, immature and sensitive protagonist of Heavy; Emma Thompson, a bereaved young widow in The Winter Guest; Albert Finney, an aging, lonely homosexual who finds some measure of intimacy while directing amateur plays in A Man of No Importance; Jack Lemmon as a desperate and demoralized worthless land huckster in Glengarry Glen Ross.

II. Mood

Film can also, most wondrously, set an overall mood, a tone to the world on screen, that can induce an inner feeling state in the viewer that may be similar to what the screenwriter or director imagines as the inner feeling state of the major characters. Photography, setting, lighting, costume, music and editing all can be employed to aid this purpose. Recently watching again Michelangelo Antonioni's 1960 masterpiece, L'avventura, I was astonished by the atmosphere of numbing depression and estrangement conveyed in that film, and by the way in which all the elements were built up to achieve this effect: the use of many shades of black and white (all grays, really) rather than sharp contrasts or color, the interminably slow pace (and it's a long film at 145 minutes), the power of a half deserted hotel or an uninhabited island setting to diminish and isolate the characters, the suppressed emotion of the players. One inexorably feels impinged upon by the bleakness of these bored, well off people. In the recent film, Pi, Darren Aronofsky employs strongly contrasting black and white images, jerky handheld photography, bold editing and touches of magical realism to impart the sense of paranoid fear and feverish preoccupation that increasingly engulf the protagonist, a mathematician with migrainous fits who is obsessed with discovering formulas that explain how everything in the world works. The viewer exposed to these marvelously employed effects is hard pressed after awhile not to feel as desperate as the hero appears to be.

III. Character

Emotional expression is one aspect of character - which consists of a person's habitual and abiding values, expectations, perspectives, the capacities for intimacy, for work and for change, whims, quirks, perversions, ambitions, vulnerabilities, habits of feeling, thinking, conduct, mannerisms, expression. As the Reichian psychotherapist, Alexander Lowen, demonstrated, character shows through in surprising ways in physical posture, movement and gesture, as well as in modes of speech. Movies thus can give us not only emotion but many other ingredients of character as well. But then only if (big if) the screenwriter and the director, as well as the actor, all understand the character and get it right. Sometimes, even though the acting is satisfactory, a character doesn't ring true. Isn't written true. Take the popular 1997 movie, As Good as it Gets. The character played by Jack Nicholson not only has symptoms of obsessive-compulsive disorder (OCD), but has an obsessive - compulsive character to match: rigid, insensitive, callous even, passively hostile. Certainly not all sufferers of OCD also have OC personalities. But such a combination is not uncommon. So far so good. But while OCD symptoms - such as repetitive, unnecessary hand washing, counting, checking the door locks, or not walking on cracks in the sidewalk like Nicholson does - are treatable and changeable, the character traits of OC personality are notoriously intractable. When Nicholson's character metamorphosed into a curmudgeonly sweetie pie, my interest in this film faded fast. (My partner very much liked As Good As it Gets...the changes in Nicholson's character didn't bother her one bit. My partner was a fine violinist. It makes her cringe to see badly simulated violin playing in films. She literally averts her gaze. I don't know enough about the violin to notice that, but when character is false, it makes me cringe.)

Film is rich in wonderful and startling character portrayals that do ring true. Some movies focus primarily on provocative characters and subordinate relationships. Examples include Lili Taylor's portrayal of a paranoid personality bordering on psychosis in I Shot Andy Warhol; Laurence Olivier as Archie Rice, the egocentric, failing vaudevillian in The Entertainer; Catherine Denueve as an emotionally suppressed but elegant bourgeois woman who finds sexual release working in a brothel in Belle de Jour; Dustin Hoffman as an autistic savant in Rain Man; Meryl Streep as a guilt ridden holocaust survivor in Sophie's Choice. Nor are character oriented films limited to pathological and antisocial types. Others tell of more virtuous people whose integrity or social responsibility stand out. Like Gregory Peck as the southern small town lawyer, Atticus Finch, modeling tolerance for his young daughter in To Kill a Mockingbird. (Robert Duvall's film debut occurred in this one: his small role as a shy man suffering from chronic schizophrenia was acted to perfection.) Or Edward James Olmos as the real life barrio teacher, Jaime Escalante, in Stand and Deliver; Seema Biswas as the resourceful Bandit Queen of northern India; Gerard Depardieu as a military officer presumed dead who returns to reclaim his place in life in Le Colonel Chabert; Gong Li as the resolute peasant who presses her cause to the top levels of the Maoist bureaucracy in The Story of Qiu Ju.

IV. Relationship A shortcoming of many of these films is that with the focus on provocative and intriguing characters, we don't learn very much about their relationships, except by inference. Sometimes relationships are better evoked in film when the individual characters are not so outsized. My favorite recent examples come from Alan Rickman's The Winter Guest, in which Emma Thompson and her real mother, the actress, Phyllida Law, star as a recently widowed woman and her aging mother. Their largely failed efforts to comfort and aid one another - when it is painfully obvious that each wants so much to be loving but at the same time feels invaded and ill understood by the other's reciprocal efforts - underscore a compelling relationship that remains central throughout the film, while around these two women, three other pairs of town characters dance in and out: 11 year old boys trying to inhabit their budding sexuality, an adolescent couple who are mutually attracted, two old women whose main pastime is attending funerals. Here the naturalness and simplicity of dialogue, the containment of feeling, the balanced attention to each character and especially to the encounters between them, an emphasis on the ways in which these people support one another, however imperfectly, all these features yield a story rich in relationship. The setting helps: a winter storm encases the world in ice and silences it, and against this pale, silent, icy background the characters, all ordinary people really, burdened by the ordinary dilemmas life places before them, stand out in bold relief.

When the players are related in real life, as in Winter Guest, this can enhance the realism, the naturalness, of their on screen relationship. Several other wonderful examples come to mind. Henry and Jane Fonda offered a poignant encounter between an aging father and his daughter in On Golden Pond, and afterward Miss Fonda said that the experience of working with her father in this film had helped to improve their long conflicted relationship. Ryan O'Neal and his young daughter Tatum were captivating as a 1930s con man and his kid in Peter Bogdanovich's Paper Moon. Brothers Jeff and Beau Bridges created a delightful fraternal relationship as a fading cocktail lounge duo in The Fabulous Baker Boys. Movies that focus on extended families typically subordinate individual character to relationships. Among the best are Woody Allen's Hannah and Her Sisters, Ingmar Bergman's Fanny and Alexander, and Ang Lee's Eat Drink Man Woman, each a celebration of family relationships.

Besides Winter Guest, other recent films that succeed in portraying relationships while understating individual character include Jonathan Nossiter's Sunday (fine and complex, enigmatic roles by Lisa Harrow and David Suchet); the popular Czech film, Kolya (a rare instance of an adult- child relationship on film that is totally charming but never syrupy); John Sayles' Lone Star,a splendid story of enduring and intertwining connections among the inhabitants of a Texas border town; Gillian Armstrong's Last Days of Chez Nous, in which Lisa Harrow plays a writer burdened by vexing relationships with her quirky French spouse (Bruno Ganz), troubled sister and irritable father; and British director Mike Leigh's Secrets and Lies, in which a working class woman is doubly surprised when a young woman - a child she adopted out at birth and never saw - comes seeking her roots.

The most memorable movies about relationships, though, are those in which all the elements come together: an underlying mood consistent with the human drama at hand; strong and provocative characters, who express emotion with suppleness and authenticity; and engagement of the characters in love, combat or the surmounting of adversity in such a manner that their interactions are enhanced by their individual foibles, not in competition with them for the viewer's attention. I mentioned The African Queen and Who's Afraid of Virginia Wolfe? at the beginning because these films bring all the elements together so well, establishing a sort of balance or reciprocity, a synergy between individual characters and their relationships. For better and for worse, respectively, these two films show us an important truth about human nature: that it is often the encounter between human beings that reveals their character, exposes their true colors as opposed to their social personas. (The human confrontation with stressful life events also evokes character, but that is a subject in itself.)

Five recent films offer good examples of outsize, emotionally compelling characters who are also able to establish strong and interesting relationships: Silence of the Lambs, The Piano, Farewell My Concubine, A Pure Formality and Shine. In Silence, Anthony Hopkins as the sophisticated criminal psychopath, Hannibal Lecter, would have stolen the show were it not for an equally fine performance by Jodie Foster as his police cadet interrogator. His veiled violence is all the more chilling because of the fear it evokes in Foster (and in us as we identify with Foster's character). Her fortitude despite her anxiety in joining the relationship intrigues Lecter and brings forth his murderous lust. Jane Campion's The Piano features three divergent characters in an isolated New Zealand setting: a voluntarily mute woman of volcanic passions (Holly Hunter), her patient and kindly husband (Sam Neill), and their strongly sensuous Maori neighbor (Harvey Keitel). Movements among these three open wide their characters and their actions tumble out of control toward inevitable tragedy. Leslie Cheung and Zhang Fengyi create an astonishing 50 year long relationship as male stars of the Peking Opera against the tumultuous background of events in a radically changing China, in Farewell My Concubine. Gong Li completes a love triangle that proves ruinous for everyone.

A Pure Formality is a triple treat. Two strong performances by Gerard Depardieu and Roman Polanski. The engrossing story of a well off man (Depardieu) whose character foibles lead to his destruction. And most importantly a riveting encounter between this man and the police inspector (Polanski) who detains him, in a setting that is...what? A dream? A place that is dark and damp where the clocks don't work. The Jungian psychotherapist, Thomas Moore, would say it is a setting for the soul. It is through the extraordinary battle of wits between these two men that the protagonist comes to understand the riddle of his misdirected life. In Scott Hicks' Shine, Geoffrey Rush so perfectly portrays the pianist David Helfgott's unusual mental illness (schizoaffective disorder, manic type) that I was able to make this difficult diagnosis watching the movie (later confirmed in an article on the film in the New York Times). Rush's highly energized, eccentric performance might have eclipsed other features of the film, but a powerful if destructive relationship between Rush's Helfgott and his uncompromising father, played with equivalent intensity by Armin Mueller-Stahl, also graces this film, and we can see how their conflict sets in motion the circumstances conducive to Helfgott's first psychotic episode in London.

V. Psychotherapy Relationships on Screen

I wish that I could as easily illustrate the film portrayal of psychotherapy influencing human affairs. There is an irony here. One might think that a legitimate therapist-patient relationship - one that is ethical and that reflects authentic standards and methods of practice, while at the same time employing dramatically interesting characters - should make for more than a few intriguing stories. This seems especially likely because, as Ted Mahar, who reviews films for the Oregonian, used to tell film criticism classes at the Northwest Film Study Center, much of North American and Western European film is permeated by the psychoanalytic perspective. Many of the actors, directors, screenwriters and even the money people have been or are being psychoanalyzed. But when I search for substantive therapist roles in the movies, I find only a handful. Many movies show therapists in brief roles that suggest they are ineffectual, irresponsible or merely an extravagance of the neurotically well off, as in the films of Woody Allen. Some films cast a character as a therapist, or employ a therapy relationship, simply as an ironic dramatic device to highlight the therapist’s personal problems (for example, Agnes of God, Happiness, Man Facing Southeast). Even so, bad therapy by a troubled therapist can on occasion yield good drama (Equus) or comedy (Don Juan DeMarco).

Alfred Hitchcock's Spellbound offers an especially corny psychoanalytic tale but is noteworthy for being among the first films to build a story around a psychotherapy relationship and for its early deviation from conventional gender arrangements. This film overly dramatizes the powers of a psychotherapist (Ingrid Bergman) to heal a man (Gregory Peck) who suffers from a post-traumatic dissociative disorder, but no real effort is made to depict therapy realistically, and the couple cross the line into romance. Called by Hitchcock, himself, "just another manhunt story wrapped up in pseudo-psychoanalysis," Spellbound arrived at a time (1945) when psychoanalysis was in the first flushes of its 40 year run as the dominant force in American psychiatry.

Twelve years later, in The Three Faces of Eve, Lee J. Cobb turned in a much more credible performance as the psychiatrist treating multiple personalitied Joanne Woodward, in the screen enactment of an actual case. Cobb's therapist conducts himself in a manner that stands up well as a model today, 40 years later. He is a strong and interesting character, while at the same time he is emotionally supportive, attentive, reliable, caring, even tempered, ethical (his only transgression, by today's standards, is to chain smoke cigars during sessions). Partly the integrity of this portrayal can be credited to writer-director Nunnally Johnson, who faithfully followed the account given in a book length report of the case by Georgia psychiatrists Hervey Cleckley and Corbett Thigpen, who treated the actual patient. But Cobb deserves much of the credit as well.

In 1977 two prominent films portrayed therapist-patient relationships. Richard Burton (the psychiatrist) and Peter Firth (the patient, a stableboy with a bizarre attachment to horses) provide a dramatically remarkable encounter in Sidney Lumet's film of Peter Shaffer's play, Equus, but Burton's psychiatrist is technically atrocious. Supposedly an expert with young patients, he makes every sort of blunder imaginable: he is asleep in his office when Firth arrives for his first appointment (having impressed upon Firth at their brief initial meeting the importance of punctuality), is emotionally volatile and unpredictable (once in anger he skips a scheduled session with the patient), lets himself be manipulated, and uses hypnosis and placebo drugs without informed consent. His conduct, in short, is almost entirely self centered. He offers an excuse of sorts for his behavior in several powerful soliloquies. Like the maverick British psychoanalyst, Ronald Laing, whose writings were fashionable at the time Shaffer wrote the play, Burton’s psychiatrist despairs that his patients’ symptoms are desperate signs of sanity in an insane world, and that by curing them he is, like some ancient high priest, sacrificing their individuality on the alter of social conformity. I Never Promised You a Rose Garden, adapted from an autobiographical account by Hannah Green of her triumph over psychosis with the help of the eminent psychotherapist, Frieda Fromm-Reichmann, was also dramatically compelling. The adolescent Green was ably played by Kathleen Quinlan, and a highly accomplished portrayal of the therapist was given by the Swedish actress, Bibi Andersson, who showed gentleness, compassion, patience and humility.

Three more recent films demonstrate rather well some of the contemporary techniques of psychotherapy and counseling. Not a psychodynamic approach. But one that is far more commonly practiced these days, less expensive, and perhaps more useful to more people: direct, active engagement of the client by the therapist, at both emotional and cognitive levels, from the getgo. In Robert Redford’s 1980 directorial debut film, Ordinary People, Timothy Hutton delivers an astonishingly realistic portrayal of a bereaved, depressed adolescent, whose psychiatrist is played by Judd Hirsch. Though Hirsch’s therapist often hectors Hutton with bulletlike questions (“Why do you think that? Why? Why?”) he is at the same time engaging, caring, unafraid to offer sound advice. In Clean and Sober Michael Keaton is convincing as a man with serious substance abuse problems, and Morgan Freeman, as his counselor, very accurately portrays the confrontative, “tough love” style of therapy used in many addictions treatment programs today. In Gus Van Sant's 1997 film, Good Will Hunting, Robin Williams is believable as the therapist, as is Matt Damon, his misguided genius client. Williams’s therapist is more self-revealing, shares more of his own emotional experience with his young patient, than Hirsch’s therapist did in Ordinary People. Williams received an Academy Award for Best Supporting Actor for his performance, the first film therapist role to earn an Oscar, I believe.

VI. "Sigi" Awards

If I were to give awards for acting a therapist role based on the integrity of the therapy as well as dramatic integrity - let’s call them the “Sigmund” awards after Freud, or “Sigis” for short (Sigi was Freud’s mother’s childhood nickname for him) - my all time Sigi for best actor would go to Lee J. Cobb (for Three Faces of Eve) and for best actress to Bibi Andersson (for Rose Garden).

I could go on. There are so many other fine depictions of relationships in film that it is both difficult and, in a sense, unfair to offer so few. Viewing a film that convincingly portrays human encounters gives us pause for thought, for reflection, about our social condition. In that pause we are given an opportunity to enrich our understanding of ourselves and how we relate to the important people in our lives.

VII. Selected Filmography

Films are listed by title, director, country of origin and year of release. All are available on VHS as of March, 1999, except as noted.

Films illustrating vivid character and emotional portrayals (actor or actress in featured role in parentheses)

All articles copyright 1999, 2000, 2001, 2002, 2003, 2004 or 2005 by Roland Atkinson. Any may be quoted with appropriate credit to the author. (Some articles mentioned in reviews on other pages may not yet have been added below)

It used to make my blood boil when psychiatrists were portrayed as fools in the movies.Like Rodney Dangerfield, I thought that we don't get enough respect, not from the creators of pop culture at least.But two recent comedies have changed my point of view:Don Juan DeMarco and Analyze This.The psychiatrists in these films certainly make errors and lapse into outrageous boundary violations, so there is much to chafe about if one is so inclined.But these therapists are also sympathetic characters with foibles and limitations.And the dilemmas they create for themselves resonate with clinical experience. In Don Juan DeMarco,the title character (played by Johnny Depp) is a presumably psychotic but bright young New York tenement dweller who has adopted the costume and lifestyle of his Spanish namesake, and Marlon Brando is the psychiatrist placed in charge of Depp's care in a mental hospital where Depp is admitted on a hold after publicly threatening suicide.In Analyze This, Robert DeNiro is a mafia boss who demands that a psychiatrist (Billy Crystal) treat him for panic and depression.

These films in fact raise very good counter-transference issues.A major theme in both movies is that the psychiatrist is captivated by the prospect of treating a patient with exceptional qualities the psychiatrist himself seems to lack.Treating such a patient appeals to the vanity of the therapist, provides a narcissistic quick fix that inflates the psychiatrist's self esteem, which in turn leads to errors in judgment that result in ethical dilemmas.Sound familiar?In Don Juan, Brando's psychiatrist is close to retirement, and both his career and his marriage are in the doldrums.He envies Depp's character's youthful sexual exuberance and identifies with it.Depp's character, like a smart manic patient, soon surmises this situation and plays to the psychiatrist's vulnerabilities.Most of us have experienced something similar - when patients accurately enough perceive that we are passing through difficult times.

In Analyze This, the mafioso oozes raw power and authority, traits that appear to be distinctly lacking in the Crystal's insipidly mild mannered therapist.DeNiro's character uses intimidation and threats to force Crystal to continue treatment against his better judgment.But by this time his fascination with this difficult patient has made any other course of action impossible.Besides, the threats appear to be real. What would you do if a seriously (not to mention effectively) violent man idealized you and your ability to treat him, and threatened you and your family unless you did?Far fetched, you say?I think not.I can think of situations with several patients suffering from paranoid schizophrenia, or borderline personality disorder, where such themes emerged.

These films, for all their farcical hyperbole, in fact tread on sensitive ground for psychiatrists.And how pleasant it is to be reminded of such matters, not during a dour case conference or, worse yet, in the throes of a tense clinical encounter, but while chuckling, relaxed and anonymous, through a funny movie.

American films have for decades been influenced by psychoanalysis.While analysts themselves might think this only natural on the merits of their views about human nature, Ted Mahar, longtime film critic for the Oregonian, once offered a more immediate reason.He thought it was because most of the directors, actors, screenwriters, studio executives and investors had been or were being analyzed.It's true that in the 30s and 40s, many European analysts resettled in Los Angeles or New York City, where most films are made.The first Hollywood film to feature an explicit psychoanalytic theme was Alfred Hitchcock’s 1945 release, Spellbound.The producer, David O. Selznick, fresh from a brief period of personal analysis with May Romm, insisted that a reluctant Hitchcock play up the psychoanalytic theme and retained Romm as a consultant for the film.During training at UCLA in the 60s, I often passed people like Lee Marvin or Burt Lancaster heading for their appointments with my professors.We residents discussed the fate of the late Marilyn Monroe in seminars with her analyst, Rommie Greenson.So Mahar had a point.Psychotinseltown.At any rate, the psychoanalytic influence has remained evident to the present day, most recently in the late Stanley Kubrick's final film, Eyes Wide Shut.

In Eyes, a young Manhattan society physician (Tom Cruise) is stunned when his wife (Nicole Kidman) tells him that while on vacation the prior summer she had felt highly sexually attracted to a stranger staying at their hotel (nothing came of it).This small revelation comes just after he had been summoned to examine a nude, drugged prostitute at the home of a friend (Sydney Pollack), and was later that evening propositioned by the daughter of a patient of his who had just died.This concatenation of events seems to seize the young doctor, propelling him into a vortex of sexual and jealous obsession that pulls him off into the night, away from his wife and toward some inchoate erotic awakening.Suddenly the world is alive with sexual intrigue.A street prostitute befriends him.Through a chance meeting with a medical school classmate, he attends a gothic masked orgy for the rich and powerful.Between these and other encounters the doctor is tortured by fantasies of his wife making love with the stranger, spurring him on to his next misadventure.Or is all of this simply a bad dream?We can’t be sure.Even the film’s title is tantalizingly ambiguous: does it refer to the doctor’s dreaming or to his naivete?

This work has the feel of most Kubrick films: a chilling, pristine, almost clinical sterility to each set and scene, the camera weaving along its quiet, probing path like an endoscope, actors used more as set pieces than real people.But for this discussion, the important thing is the story.It is based on a short novel, "Traumnovelle" ("Dream Story," or "Rhapsody: A Dream Novel" in various English translations), written in 1925 by Arthur Schnitzler, a Viennese physician, playright, novelist and sexual athlete who apparently was an acquaintance of Freud's.Schnitzler's story bears the clear stamp of early psychoanalytic thinking. Sexuality is the prime source of human motivation.Dreams and fantasies develop the vividness and press of reality itself.A person whose own sexual awareness has been limited by repression may, if traumatic circumstances weaken his defenses, be flooded by impulses that both frighten and fascinate him, and, in any case, leave him helpless in the face of their dark libidinal power.The artifices of the ego are no match for the volcanic forces of the id.

All of this is quite fitting for a Viennese novella written in the 1920s and set in the 1910s.Indeed, Schnitzler was a modern psychological writer for his time.But Kubrick and his cowriter, Frederic Raphael, made a pivotal and, I think, bad decision to update the story from 10s Vienna to 90s New York City. The notion that a slick young society physician in 1999 could be the sexual naif portrayed here, is plain silly.That this doctor could become so undone when his glamorous wife confides that she had felt turned on by some guy she once saw, is not believable.A flair of jealous feelings and fantasies - yes.Some talk about how the marriage is going - clearly in order.A few visits, at least, with a therapist - perhaps.

Not only do people differ in other times and places, but, as we know, psychoanalysis itself has come a long way since the 20s.The resources of the ego are now regarded as far more extensive and sophisticated than the early Freudians believed.Interpersonal (not just sexual) relations and self regard are considered to be central to motivation and behavior.Like the book, Eyes Wide Shut should have been set early in the century.That would have been consistent with its psychological premises.And it surely would have resulted in a more believable film, if not a better one.

Watching James Mangold's new film, Girl, Interrupted, I was overwhelmed with a sense of familiarity.In nearly every way, this film about young women treated at the McLean Hospital in Massachusetts in the late 1960s reminded me of the way things were on the wards at UCLA when I was a resident in 1963.The place is clean and generally well run, and the staff-to-patient ratio appears to be favorable.The nursing staff are all believable characters: the naive young man who lets himself be seduced by a patient, the primly rigid older nurse, the timid young one, and Valerie, the head nurse, played with wonderfully proportioned warmth and authority by Whoopi Goldberg.Power struggles of a subtle sort occur between patients and staff, but there is none of the sadism in the name of treatment that marks films like Oregon's own One Flew Over the Cuckoo's Nest or the fine Australian film, An Angel at My Table.As Goldberg's character comments at one point, "I've worked in state hospitals, and compared to them, this is a five-star hotel."She's right.

The film follows the encounters and antics of a half dozen teenagers who try to cobble together some sort of normal adolescent experience within the bizzare confines of the hospital milieu.They pull pranks just like our young patients did at UCLA.Although these particular young women are not psychotic, most have remained on the ward for months or even years (our voluntary patients often stayed for 3 to 9 months, sometimes longer).One is reminded by these long stays of how our profession squandered precious treatment resources in that era.On the other hand, without big bucks or a benevolent relation to take you in, where can anyone go these days who genuinely needs asylum, a timeout that lasts longer than 5.3 days, an "interruption" when life has become an unbearable routine?I suppose that’s what prisons are for nowadays.

The realism of this film is undoubtedly influenced by the source material, an autobiographical account of the same title by Susanna Kaysen, who is the film's central character (played by Winona Ryder).Susanna (Ryder) is depressed, painfully thin and pasty looking, pops pills and booze, fails in school although bright, is impulsively promiscuous, makes a suicidal gesture, and lands on the ward. She carries the diagnosis of borderline personality disorder, although as played here she seems more to suffer from a straightforward depression, never displaying the faulty capacity for relationships that is a trademark of borderlines.She meets Lisa (Angelina Jolie), who steals a number of scenes as a sexy, hypomanic troublemaker.Labeled an antisocial personality, her anger and capacity for splitting (polarizing people's feelings toward her, stirring up controversy) is much more the stuff of which borderlines are made.Their buddies include a pathological liar, another with an eating disorder, and a third who has burned her face and body (Lisa calls her "Torchy").All these folks pretty much ring true, even if the diagnostic labels applied to them are a bit mixed up.I knew kids just like them on our wards.

As for the psychiatrists, they vary from the clueless Dr. Crumble, who arranges Susanna's admission, to the bumbling but sincere doctor everyone calls "Melvin," to the arresting Dr. Wick (Vanessa Redgrave), who heads the hospital.Redgrave's psychiatrist is wise, restrained and empathic, and had the role been created as more than a cameo, her performance might rank right up there close to Bibi Andersson's, when she played Frieda Fromm-Reichmann in the 1977 film, I Never Promised You a Rose Garden.I consider Andersson's performance the best ever portrayal of a psychiatrist by an actress.

Mangold, who cowrote the screenplay and directed, shows here once again his gift for evoking well nuanced, believable portrayals of troubled personalities.He demonstrated this first in Heavy, in which Taylor Pruitt Vince is heartbreaking as an overweight, introverted, dependent personality, and then, in Copland, where Mangold somehow drew from Sylvester Stallone a performance as unexpected as it was poignant, playing a sad, propped-up small town sheriff who had failed to fulfill any of his life's dreams. Now Mangold proves he can work just as effectively with actresses.

All of this said, Girl, Interrupted is not a great film.Clinically realistic?Yes.So much so that after the wonder of deja vu had worn off, I found it all a bit boring, too much a busman's holiday (although my partner, who is not in the mental health trade, found it absorbing throughout).Certainly there are films set in mental hospitals that work better as dramatic entertainment, Cuckoo's Nest, Angel, and the incomparable King of Hearts, among them.All take ironic advantage of the grimmer setting of public mental institutions to add tension and poignancy to their stories of the human condition.But give Mangold and his cast an "A" for authenticity.

Back in June, the National Alliance for the Mentally Ill (NAMI) made quite a fuss about Bobby and Peter Farrelly's new comedy, Me, Myself and Irene, starring rubberfaced Jim Carrey as Charlie, a mild mannered state trooper who develops a nasty alternative personality, "Hank," and gets labelled schizophrenic. NAMI's Executive Director, Laurie Flynn, launched a national protest, claiming among other things that the film shows "gross ignorance and insensitivity" to the mentally ill, perpetuates a myth that schizophrenia and split personality are synonymous, and misinforms teens about the true early signs of schizophrenia. She deplored an ad campaign for the movie that includes "stigmatizing" posters (they say 'from gentle to mental'), T-shirts, and bottles of psychotherapeutic "pills" (white jelly beans).

It may be no coincidence that the same week Ms. Flynn went on the attack, Tipper Gore launched a Mental Health Awareness Campaign from the White House, targeting in particular the problem of the stigma of mental illness among youth, the major consumers of films like this one. Even in the Op-Ed pages of "The Oregonian," Robert Landauer took up the cause, indicting the film, not because it "...exploits mental illness for laughs [which he defends]. The issue is that the film misrepresents mental illness in ways that will cause or increase harm." His specific charges: the film confuses schizophrenia with multiple personality disorder, equates mental illness with danger to others, and portrays schizophrenia as a joke (he fails to explain how this differs from exploiting mental illness for laughs).

The Farrellys (Dumb and Dumber, There's Something About Mary) routinely revel in gross ignorance and insensitivity and pander to cultural stereotypes and myths. Everyone under the age of 25 who attends a film made by these people knows that they will see lots of stupid coarse dumb stuff. This movie is like their others. And the mentally ill fare no worse here than African Americans or dwarfs, and a good deal better than law enforcement officers, none of whom are protesting to my knowledge. (In one of the film's less ennobling sight gags, Charlie's three black teenage sons - whose birth father was a dwarf who had an affair with Charlie's wife and later ran off with her - handcuff a sheriff's deputy, pull his pants down, and leave him with a live chicken's head stuck up his rear end.)

Now for the specific charges: does the film confuse schizophrenia with multiple personality? Yes, but who cares. People have been doing that for eons without a shred of evidence that such a misconception ever harmed anybody. Does the film equate mental illness with danger to others? No, certainly not in any sweeping sense. Granted, "Hank" can become sexually intrusive, although Charlie and the woman he pursues are in fact falling in love. He does retaliate a bit against some neighbors and townsfolk who had been pushing Charlie around for years. And at various points Hank briefly frightens a child, insults an albino server (whom he calls 'Q-Tip'), and sucks milk from the breast of a nursing mother.

But his aggression is for the most part just bluster...Hank routinely loses every actual fight he picks. Nor is there any dialogue by anybody about the dangerousness of the mentally ill. Does the film portray schizophrenia as a joke? No. In the first place, there is nothing in Carrey’s actions that remotely suggests any sign or symptom of schizophrenia. The word itself is mentioned only twice, rapidly, as part of a long diagnostic litany. Beyond that, the first 40 minutes of the film are taken up showing us why we should feel sympathetic about Charlie's repressed rage that eventually becomes manifest in “Hank's” nastiness. The real point here, though, is that what nearly everybody thinks about while watching this film is not schizophrenia or mental illness at all. What we are thinking about is the amazing capacity of Jim Carrey to rapidly alter his physical expression of character between wildly divergent extremes, and wondering what antic he will spring on us next.

Me, Myself and Irene is a terrible film. It is banal and dull, but it breaks no fresh taboos. If enough people pay to see it, and its investors reap a decent profit (it grossed $55 M in its first two weeks), then it fulfills the essential Hollywood criterion for quality entertainment. If, on the other hand, NAMI wants to exploit an opportunity to communicate with teens by chafing about this film's excesses in the media, I suppose that's fine too. Everyone's entitled to their First Amendment rights. But compared to the silly stuff in this film, the serious misrepresentations of teen depression and suicide in the new film, The Virgin Suicides should cause misgivings for Tipper Gore, NAMI and anyone else interested in preventing adolescent suicide.

In The Virgin Suicides, first time writer-director Sofia Coppola has created an absorbing film, the story of a family in which five teenage sisters kill themselves.The screenplay is based on a fictional account by Jeffrey Eugenides, set in a 1970s Michigan suburb.Cecille, at 13 the youngest of the sisters, cuts her wrists.An attempt at therapy appears to fail.She seems low, withdrawn.Her parents understandably are nervous.A few weeks after the event they throw a teen party in her honor.She excuses herself and jumps to her death off an upstairs balcony.The mother (a hulking Kathleen Turner) becomes painfully depressed.The father (James Woods), a mild mannered math teacher at the high school, just zones out.The four surviving sisters - ages 14 to 17 - seem after a while to carry on rather well, although the pall in the household remains, a pall conveyed almost palpably by the use of subdued lighting, unkempt belongings and unwashed dishes strewn here and there, diseased trees being condemned by the city.

Months go by, and then, after one of the middle sisters, the sexually provocative Lux (Kirsten Dunst), stays out all night on a date, mother cracks down - fanatically, viciously.She pulls all the girls out of school, and the entire family goes into an acute regressive, shadowy, isolated tailspin of bare existence, cut off from everyone.After two weeks of imprisonment, during which the girls seem mainly bored, except when amusing themselves by playing telephone games with neighbor boys, the sisters successfully carry out a mutual suicide pact.The parents put the house on the market and drive away, never to be seen again.End of film.

There is much that is good, even outstanding, in this film.Like American Graffiti, it tells of the longing of adolescent boys for girls instead be for other boys) and for their own emergence as men.It is also the compelling story of a family, the Lisbons, a deeply repressive, conventional, Roman Catholic family, ruled by a powerful, brooding woman, who through the force of her indomitable will is attempting to insulate her daughters from the perils of 70s youth culture.This family is the polar opposite of the 70s family depicted by Ang Lee in Ice Storm, whose members are spinning out of control as the adults try to outdo the kids in seeking sexual and other thrills.

Beyond these convincing aspects, this film is clinically puzzling. It doesn’t ring true.For one thing, while the shrouds of tragedy that envelop the Lisbon family seem to suffocate the parents and the viewer alike, the surviving daughters seem strangely immune to this pall.The film implies that teen suicide occurs unpredictably, for mysterious reasons, even in youngsters who appear resilient and full of good cheer.(One can almost hear the familiar refrain: 'Ah. Kids. Who can understand 'em?')In fact, as we know, typically there are warning signs before teen suicide: depressed mood, change in personal habits, decline in school performance, social withdrawal, substance abuse, and so on. The film further suggests that repressive, controlling parents drive their children to suicide.But rates are known to be lower in close knit religious families, higher when parents are absent or indifferent.Cecille's psychotherapist is portrayed as worse than useless: a cameo by Danny DeVito wearing a fake beard and administering a Rorschach test on the first visit.The truth is that even brief psychotherapy can favorably influence many demoralized teens. So these are all false depictions.This film even hints that suicide might somehow be associated with the mysteries of adolescent female sexuality, with clever secret pacts or hi jinks.Sorry, but this is bogus.

Teen suicide is not an uncommon theme in the movies.Think of the black comedic suicide gestures of Bud Cort in Harold and Maude;the doomed young lovers in Elvira Madigan; the realistic suicide of a young psychiatric patient in the recent Girl, Interrupted.The cinematic "gold standard" here is Robert Redford's 1980 film Ordinary People, in which Timothy Hutton so ably portrays a depressed, guilt-ridden teenager who eventually attempts suicide.There is no ambiguity here.Hutton's nihilism emerges from obvious and terrible pain.Nor can the problem be easily fixed in his case, even with the aid of a good psychotherapist (Judd Hirsch).But there is no mystery, no cheapening of suffering by suggesting its absence, no message that seeking help is a waste.Compared to the silly stuff in a film like Me, Myself and Irene, the serious misrepresentations in Virgin Suicidesshould cause misgivings for Tipper Gore, NAMI and anyone else interested in preventing adolescent suicide.

Foremost among the major psychiatric syndromes, alcoholism has been very well depicted on screen in several memorable films over the years.For starters, who can forget City Lights (1931), offering the first film demonstration of state dependent memory, when Chaplin's little tramp is only recognizable to his wealthy drinking partner and benefactor while he is soused?Then there are such classic alcoholic roles as Ray Milland’s in The Lost Weekend (1945) or Jack Lemmon’s and Lee Remick’s in Days of Wine and Roses (1962). These films not only dramatized the lurid details of compulsive drinking and D.T.s, but also ably demonstrated codependent relationships, years before that term permeated popular culture.

That the nuances of alcoholism should apparently be so accessible to filmmakers is, on the one hand, no great surprise, for notorious examples certainly abound in Hollywood.Recalling some famous drunks of filmdom is easy enough, whether screenwriters, actors or directors: think of William Faulkner, Richard Burton or John Huston.But then most people - in and out of film - also know depressives and schizophrenics.Yet these "types" are not so often well portrayed on screen, compared with alcoholics.Why the difference?Intimacy with the subject may be one factor, granted, but another may simply be that alcoholism is more photographable.Schizophrenia, after all, is largely a disorder of internal experience (thinking, feeling, perceiving), while people suffering from an episode of depression by definition tend to constrict their emotional expression and behavior.Alcoholics often behave extravagantly while intoxicated, manipulate other people in provocative ways, and frequently cause major social and physical damage.There can be a lot for the camera to see while following an alcoholic around.

Here are five more recent films that view alcoholism from different perspectives: Clean and Sober,Once Were Warriors from New Zealand, Georgia,the British film My Name is Joe, and the recently released 28 Days *In Clean and Sober, Michael Keaton plays an ace real estate salesman who becomes hooked on cocaine and alcohol.His arrogance and in-and-out flirtations with treatment ring true.Morgan Freeman offers an equally convincing portrayal as his counselor, dispensing confrontive "tough love" as needed. Clean and Sober arrived at a time when 12-step recovery programs were becoming all the rage in Hollywood, and talk show hosts quipped that the place to catch a show biz bigwig hanging out was no longer at some fancy watering hole but at a meeting of Alcoholics Anonymous.

Once Were Warriors is a powerful story about rural Maori uprooted to the city, and it depicts how drunkenness becomes intertwined with socioeconomic and family problems of a disenfranchised group. It could as easily be a story of Native Americans or any other marginalized minority. For her work in Georgia, Jennifer Jason Leigh won the New York Film Critics best actress award. Her jarring portrayal of a strident, hyperactive Seattle grunge singer strung out on alcohol and drugs is agonizing to watch but vividly real. My Name is Joe offers finely nuanced performances and an intriguing examination of problems that can face a recovering alcoholic. Peter Mullan, in a role that won him best actor honors at Cannes, is struggling to put his life together, living on the dole in a disadvantaged Glasgow neighborhood. Mullan's Joe captivates as a wild, vulnerable and sometimes violent man who is at the same time principled and decent. As if being a big brother to a group of marginal younger men were not burden enough, he falls in love with his caseworker, who predictably finds that she has gotten into something way over her head. Her brittle morality overcomes her attachment to Joe, with disastrous consequences. Everyone in this film talks in indecipherable working class Scot-speak, but, mercifully, English subtitles are provided! In the comedy 28 Days, Sandra Bullock stars as Gwen, an alcoholic, pill popping writer who is court ordered into a chemical dependency program after a drunk driving accident. This send up of residential treatment is by turns improbably corny, genuinely funny, and also, yes, sobering. Gwen's rapid progress is perhaps too good to be true, but beneath the hyperbole the basic lessons of early recovery are all covered.

Any of these films could well complement an introductory course on alcoholism.___________

Among recent examples of national lunacy, perhaps none outranks our “War on Drugs.” The first shot fired over the bow was the Harrison Act of 1917, but the battle began in earnest during the Nixon administration, in response to widespread illicit drug use in the 1960s and early 70s. Since then hundreds of billions have been spent in exponentially increasing amounts, more than two dollars for law enforcement to every dollar for treatment (and, in comparison, about 12 cents for research). By most measures, this effort has been a collosal failure. The street prices of heroin and cocaine have been declining steadily for years, drug purity has increased, and the number of drug-related emergency room visits has risen. These are clear indicators that drug supplies have become more plentiful despite massive U.S. sponsored interdiction efforts in Colombia, Mexico, Peru and elsewhere. One cartel is toppled, one jungle-based factory destroyed, and others spring up overnight. The drug trade is so profitable, and the economic plight of most Latin Americans is so desperate, that traffickers can always recruit help despite the hazards and reckon on up to 90% loss of product and still prosper. Domestic interdiction efforts fare no better, for similar reasons.

Meanwhile effective treatment options exist that can reduce drug demand.Arizona's recent effort to treat, not imprison, nonviolent drug offenders has saved millions and reduced recidivism.But treatment nationally is seriously underfunded, even according to outgoing drug czar Barry McCaffrey (the most aggressive Army general in the Gulf War, McCaffrey has been the perfect embodiment of a drug warrior).Waiting lists for drug treatment number in the 100s to 1000s in most cities. As Mexico's new reform-minded president, Vicente Fox, rightly points out, America's drug problem cannot be solved without efforts to reduce demand, and that means more support of treatment and prevention programs.

The public's appetite for a tough approach to drugs became so voracious and unquestioning in the 1980s that most politicians were and still are terrified to confront the war’s failures and destructiveness.Small wonder, then, that moviemakers have preferred to offer films that portray the lurid horrors of drug addiction (from TheMan with the Golden Arm to Requiem for a Dream) while avoiding the incredibly convoluted, often ironic story of our contemporary drug problem.Now, at last, many of these issues are confronted in Steven Soderbergh's new film Traffic, a brilliantly conceived and compelling examination of our drug problem in much of its awful complexity.

The film weaves among three color-coded stories. First there is the Mexican story (with segments in sepia-tone), full of treachery and double dealing, in which everyone appears corrupted in some way, up to the top echelons of Mexico City officialdom. Then there is the Cincinnati-Washington DC story (with segments tinted blue), in which a respected federal judge is tapped to become the nation's new drug czar, while back home his 16 year old daughter is secretly spiraling downward into hard drug addiction. Finally there is the San Diego story (in bright, full color) of a socialite whose husband turns out to be a major drug distributor, and the DEA agents who try to get the goods on him.By the end several people have died and no real progress has been made, although the final scene is not one of cynicism but of hope as the drug czar’s daughter speaks tentatively but positively to her fellow addicts at a self-help group meeting.

Traffic fails to address important aspects of the war here at home, against U.S. citizens.Prosecutorial rights have flourished at the expense of individual liberties, especially privacy rights.Here's one example to show how far things have gotten out of hand: in a case currently under review by the U.S. Supreme Court, a university teaching hospital in the south routinely gave information on illicit drug use by (mainly black) pregnant women to local authorities while these patients were hospitalized for delivery and without their knowledge or consent.This arrangement enabled the efficient arrest of the women as they were being discharged from the maternity ward.Our "zero tolerance" mindset precludes public health measures to reduce drug-related illnesses (e.g., needle exchanges), and frequently negates important distinctions between relatively safe versus harmful drugs, and between possession of small amounts versus distribution of large amounts.Severe mandatory sentencing for drug offenses prompts drug kingpins to plea bargain by naming less dangerous underlings, who in turn end up with more severe sentences.Mainly thanks to the war, the U.S. now has the highest rate of incarceration in the world, including untold numbers of ordinary people who have been criminalized for minor drug violations and an estimated 400,000 (22% of all inmates) with drug addictions.

Despite these omissions, Traffic is a profound and honest film, one that raises questions but never preaches.Example: the new drug czar is flying with Washington drug war higher ups to inspect border interdiction efforts.He asks if anyone representing treatment is on board.There is only silence.Then he asks for new ideas on reducing the drug problem.More silence.Although complex, the interposed and partially overlapping stories are easy enough to follow.The large acting ensemble is uniformly excellent.Soderbergh is an amazingly spare and efficient filmmaker: he never wastes time or footage.There is a tightness, a well-fitting integrity, to his pictures that reflects craftsmanship of the highest order (also apparent in his films Out of Sight and The Limey).Soderbergh himself photographed this film with a Steadicam, and his excellent shooting creates an intimate verite quality to many scenes.This film succeeds brilliantly as drama and as social commentary.

Popular sentiment about the war seems to be shifting.Emergence of a high budget mainstream film like Traffic itself suggests this.Some physicians are beginning to speak out against the war, like the national group co-led by OHSU trauma surgeon Donald Trunkey.It was a ballot initiative, not the political will of its leaders, that launched Arizona’s program of treatment instead of prison for nonviolent drug offenders, and California just passed a similar initiative last November.The public could very well be out in front of our leaders now in pressing for a more rational approach to the drug problem.

George Vaillant, in the introduction to his book,The Wisdom of the Ego, reminds us that all mental mechanisms result in some degree of self deception, because we all need to turn a blind eye to reality at times to help us persevere through life's ordeals.This is a major subtext of what is undoubtedly the quirkiest musical film ever made, Lars von Trier's Dancer in the Dark,* which won awards at the 2000 Cannes film festival for best picture and best actress (the Icelandic pop singer, Bjork).*

'Dark' in this film’s title conveys two meanings.Selma (Bjork) is fast losing her eyesight from a hereditary condition.She is also an emotionally intense person who often hides behind a facade of childlike insouciance.And when the going gets really rough, as it does for her in a rapidly downhill spiral of events, she dissociates.She fantasizes herself and the other people around her suddenly breaking into zippy song and dance routines reminiscent of Broadway shows, or, in her case, performances back home by a man named Novy, who was famous when she was a little girl.In this manner she is able for the moment to shut out the awful circumstances in which she finds herself.

Selma is a Czech immigrant who has come to the US to find medical help for her 12 year old son, who will otherwise lose his eyesight from the same disorder.It is 1964 and Selma is working in a factory in a rural town in Washington state, running a sheet metal press, scrimping to save for her son's operation.Her best friends are factory coworker Kathy (Catherine Deneuve), humble would-be suitor Jeff (Peter Stormare, last seen in a decidedly different role stuffing a body into a wood chipper in Fargo), and Bill, her landlord, a local sheriff's deputy (David Morse).

Bad things soon begin to happen, with varying degrees of implausibility.Bill - desperate and despondent because he has squandered a large inheritance and is in debt - discovers where Selma stashes the money she is saving and steals it.Selma boldly confronts him and takes back her money, but he attempts to frame her, claiming to his wife that Selma has made sexual advances and tried to steal his money.He pulls his gun to arrest her and in the struggle he is wounded.He then implores Selma to kill him (he had been considering suicide) and - lo and behold - she complies!At trial she lies that she sent the missing money to her "father" in the Czech Republic, the dancer Novy whom she had idolized as a child, because she fears that otherwise authorities will confiscate the funds and her son's sight will not be saved (if this sounds like a hundred year old melodrama plot we're on the same page). Unfortunately for Selma, the prosecution produces Novy (a dapper, tanned Joel Grey), now retired in Hollywood, and he of course testifies he's never heard of her.She is convicted and later hanged, after refusing a chance to have her sentence commuted because the legal costs would require the money needed for her son's operation.We get to see the hanging: fall, neck jerk and all.

Throughout this improbable yet sad story of Selma's figurative and literal fall from grace, the proceedings are periodically interrupted by reveries of hers in which suddenly she's free, happy, singing, twirling, usually accompanied by an ensemble of six to a dozen dancers.This happens often: in the factory (where the distractions lead to a major machine foulup by Selma that results in her being fired), right after she kills Bill (when he magically comes to life and they dance and sing together), during her trial (where the rapacious prosecuting attorney and the jury all join her and Joel Grey in a courtroom dance routine), and just before she is executed.

There is nothing wrong with these routines in themselves.Bjork wrote and delivers the songs very ably, and the dancing is good.For that matter, the acting is, with one exception, superb.The exception is Deneuve, and the problem is really not her acting, but the fact that she is so stupendously miscast.La Deneuve, as a down-at-the-heels working class rural American factory worker?I'm sure.But Morse, Grey and several others - especially Stormare and a corrections officer (Siobhan Fallon) who befriends Selma in prison - are all good.Best of all, Bjork herself is captivating as a Victorian sort of woman-child, an interesting amalgam of boldness and resolve, sweet innocence and vulnerability, pluck and self-defeating stubbornness.Just the sort to rely on dissociation, you might say.We can't know, here, how much of her transfixing screen presence and manner are essential parts of her true personality versus evidence of her acting ability.But she does seem to possess range, and she clearly deserved her Cannes best actress award.

As for the film itself, it is a huge daring mess of contrivances.Von Trier, who also wrote the screenplay and lyrics for several of the songs, dwells overly much on closeups of Bjork, and the editing is way too frenetic, almost febrile.More important is his decision to juxtapose the tragic with the frivolous.Excellent musicals often have tragic themes, of course, from the sentimental Carousel to the leather tough Cabaret, to what is arguably the best musical ever made: West Side Story.But these favorites are distinguished by the integration, the harmony, of the songs and dancing with the story line.In these works, the key musical material is itself tragic in tone, and the individual numbers either move the story along or reflect on what has been occurring.Not so in Dancer.The musical numbers here are escapist fantasies of a desperate protagonist.In theory this could work, perhaps.But it doesn't here.The tragedy of Selma's story is too appalling, the song and dance routines too starkly interruptive and incongruous.It may ring true as psychopathology but is it effective as drama?

In Roberto Begnini's Life is Beautiful, incredible scenes of slapstick gaity made a gratuitous mockery of massive human suffering in the Holocaust.Von Trier's conceit is another matter.Selma's tragedy is not trivialized here.One can imagine a person like her who copes with anguish through fantasy.But it is one thing to be prone to dissociative fantasy in one's own mental experience.It's quite another to attempt to depict such a process occurring in someone else.Almost invariably such film portrayals, whether of hallucinations or complex fantasies, tend to fail.Still, this is an outrageous and compelling film.
______________* Dancer in the Dark was directed by Lars von Trier, Denmark, 2000; although many of the players are European, everyone speaks English in this film.

I don’t watch television. But thanks to a tip from a colleague, I learned belatedly that the HBO hit series, The Sopranos, prominently features psychiatric treatment. All 39 episodes from the first three seasons (1999-2001) are now available on VHS and DVD. This review will focus only on the first season - the initial 13 episodes.This is a “family” show in a doubly ironic sense. Tony Soprano (James Gandolfini) owns a waste management company and lives with his wife Carmela (Edie Falco) and their two children in a suburban New Jersey mansion. Meadow (Jamie-Lynn Sigler), Tony’s 17 year old daughter, is engaged in typical teen warfare with her parents. Anthony Jr. (Robert Iler) at 13 is close to his dad but veering towards trouble at school. Carmela is justifiably impatient with Tony’s philandering and otherwise shadowy life. His aging mother, Livia (Nancy Marchand) is also critical of him – to her he’s a bum next to his sainted deceased father; never mind the fact that she thought the father was a bum too. And Livia is also beginning to fail.

Then there is the other family: Tony is a Capo – a “captain” – in the Jersey Mafia. Profits are down. Loyalty is on the wane. His pushy old uncle Junior (Dominic Chianese) is competing to run the mob. Life isn’t easy. Tony has become depressed and developed panic attacks, and he seeks professional help. The very first scene in the first episode finds Tony bemusedly awaiting his initial visit with a psychiatrist, Dr. Jennifer Melfi (Lorraine Bracco). She is a prominent character not only in this episode but throughout the series. Tony is not an easy patient. He often denies his symptoms and is deeply involved in illegal, and sometimes violent, activities. He is used to being in charge; the patient role does not suit him (much like Robert DeNiro’s gangland character in the film, Analyze This). Tony storms out of Dr. Melfi’s office before the end of their first hour together and will do so again. He develops an intense maternal transference, then sexualizes the relationship in erotic dreams and actual attempts to seduce the doctor. It doesn’t stop there. Tony directs a corrupt detective on his payroll to follow Dr. Melfi and report details of her personal life to him. As a gift, he arranges for her car to be stolen in the night for needed repairs and then returned. Gandolfini infuses his character with the same bristling bulldog intensity that Carroll O’Connor brought to “All in the Family.” But Tony Soprano is full of more contradictions than Archie Bunker: in some respects Tony is more modern and caring, in others far more primitive and ruthless. His attachment to his family – his wife, his children, his difficult mother and murderous uncle – is steadfast. He can be as genuinely affectionate as a puppy; guily feelings can cause him to cringe with contriteness. He can also kill people or rough them up with devastating violence and not an ounce of remorse.

Dr. Melfi is no less complex. She’s tough and confident in her personal life, even something of a foulmouth. But in the office with Tony she seems hesitant, overly restrained, softspoken to a fault, often lacking in authority. She knows from the referring physician that Tony is a Mafioso. In the first session she is especially inconsistent, shifting among three different personas. She’s the clichéd pop therapist, overselling SSRIs (“…nowadays no one has to suffer from depression,” she says) and delivering with wide eyed insouciance, almost farcically, lines like “you seem to have strong feelings about this” or “there certainly is a formidable maternal presence in your life.” Fortunately this aspect fades away in later episodes. She can also be seductive. There is a lifesize metal statue of a nude woman in her waiting room in the first epidose (interestingly it is nowhere to be seen in subsequent episodes). She wears very short skirts at times, and her soft, hesitant manner could be mistaken for coming on.However, in most respects she delivers as a competent psychiatrist. She cares; she nicely balances questions with empathic statements; she shows an appropriate sense of humor. She clearly explains confidentiality rules and limits. She properly pursues such matters as Tony’s neurotic distortions of his mother and forthrightly if quietly confronts behavior like his bringing her coffee, having her car worked on, and trying to make a pass at her.

Her competence seems to grow with time, and her reticent, gentle manner might well be viewed as deliberate, possibly the only approach Tony has the capacity to tolerate. Dr. Melfi tells him as much in the 6th episode when she says that her gentleness is a strategy she needs to use “…to do my work here.” She does commit a gaffe or two along the way. In episode 10 she volunteers that she had recently attended a dinner party at Tony’s next door neighbor’s house. This gratuitous overture of familiarity, with its hint of boundary transgression, serves no dramatic purpose and occurs when Tony’s admission of sexual attraction to her is still fresh. In the 12th episode she assertively reads to Tony the unflattering criteria for borderline personality disorder listed in DSM-IV to help make her point that his mother may merit this diagnosis. This provokes a physically menacing response from Tony that is clinically right on the mark.So, is Tony making any progress? His depressive and anxiety symptoms wax and wane. An SSRI (Prozac) was no panacea, and Dr. Melfi has had to try augmentation strategies using other medications. In later episodes there are signs that psychotherapy may be helping. Tony is taking a more realistic tack with his mother. He is able for the first time to feel compassion for a kid whom he and his friends used to torment back in school, after he himself is treated contemptuously by members of a private country club. Most important is Tony’s change of heart after discovering that the soccer coach of the girls team on which Meadow plays had sex with one of her teammates. Tony hints to Dr. Melfi that he has organized a “hit” on this man. She persistently challenges his impulse to take justice into his own hands, and later he calls off the hit in favor of letting civil authorities intervene.The nature and rules of psychotherapy are explored through the encounters between these two. Tony accuses Dr. Melfi of being a whore when she insists that he pay for a missed session, raising the old debate about whether therapy is anything more than “rent a friend.” Whether it is morally acceptable for a psychiatrist to treat a patient as corrupt as Tony becomes a subject for discussion in her family.

In a larger sense Bracco’s character can be viewed as an important dramatic device: if a psychiatrist – and a woman at that – can find grounds for empathy with this violent, contradictory man, then, through her, viewers are challenged to consider a similar perspective. Good film depictions of psychiatrists – portrayals that meet high standards for ethical conduct, a caring attitude and technical proficiency, as well as dramatic sensibility – are surprisingly few and far between. My all-time favorites are Lee J. Cobb in The Three Faces of Eve (1957) and Bibi Andersson in I Never Promised You a Rose Garden (1977). Both roles were based on real, well known psychiatrists. On television in the 1970s, the comedian Bob Newhart managed to create a character – Dr. Robert Hartley, a clinical psychologist – who maintained a principled and caring attitude toward his patients for six years in a weekly sitcom, no small task. Based on her work in the first season of The Sopranos, add Lorraine Bracco’s Dr. Jennifer Melfi to the “A” list of generally positive, authentic fictional film portrayals of mental health professionals at work.

Sad note on the sequel (the second season): In its second season, TheSopranos continues to present episodes with generally high dramatic values. However, I regret to report that the writers virtually destroyed Bracco’s character, Dr. Melfi, a role so carefully built up in the first season. Her ambivalence about treating Tony reemerges and results in on-again-off-again contacts with him. While this is in part understandable, since her life may be endangered by Mafia figures who think Tony may have told her too much, things run to improbable and unnecessary extremes. She begins to belt down shots of whiskey between sessions. She’s a nervous wreck and seeks treatment from her own therapist (Dr. Kupferman, played very ably by Peter Bogdanovich). In later episodes she seems to regain some composure but not the steady hand she showed in the earlier series. Oh, well. Sequels often disappoint. And the excellent portrayal of a psychiatrist at work in the first season still stands on its own merits.

Dr. Melfi (and psychiatry) redeemed (the third season): Overall, the dramatic luster of the series is starting to wear a bit thin. At times new variations on old themes and characters come across as merely recycling of prior material. Example: the character Ralphie (well played by a menacing, near lunatic Joe Pantoliano) is too much like the character Richie Aprile in the second season. Annabella Sciorra is outstanding as Gloria, a predatory, mercurial woman with a severe borderline personality disorder whom Tony meets in Dr. Melfi’s waiting room. Melfi herself is resurrected this season. She and her estranged therapist spouse, Richard, reconcile. She is restored as competent, insightful, at times quite justifiably assertive in her psychotherapeutic work with Tony, who continues to have panic attacks. She suggests referral to a cognitive-behavioral therapist (in part because of Tony’s refractory symptoms but also because she has come to think that she doesn’t want to continue working with him). This prompts Tony to try a little harder. Carmela joins them for several sessions. In episode 3, a decidedly psychodynamic spin is placed on Tony’s panic attacks, when he recalls the initial attack, at age 11, after witnessing his father hack the little finger off a butcher who hasn’t paid his protection money. This psychodynamic explanation of Tony’s disorder is overly pat and dated. Tony’s son, A.J., also begins to have panic attacks (we know it runs in families). In episode 4 Dr. Melfi is raped in her office building parking garage, and the rapist, whom Melfi can identify, is not prosecuted on a technicality. Why she is put through this ordeal is unclear. She is understandably vengeful and must stifle an impulse to have Tony arrange to punish the rapist. The highly inappropriate, lifesize statue of a nude woman, not seen since the premiere episode in the first season, reappears in Melfi’s waiting room in episodes 7 and 11. On advice from Dr. Melfi, Carmela consults a psychiatrist who had been one of Melfi’s mentors. Dr. Krakower (Sully Boyar) is excellent in a single cameo, urging Carmela to leave Tony and refusing payment because he won’t work for “blood money.” He neither condescends nor minces words. Karl Menninger, who advocated that therapists give advice when patients act destructively, would have been proud of Boyar’s performance. (Boyar died two weeks before this episode first aired; Nancy Marchand, who played Tony’s personality disordered mother, Livia, also died late in the second season; she receives a funeral in episode 2.) In summary, Dr. Melfi and psychiatry are redeemed this season, after taking a serious hit the year before. Yet Melfi’s rape seems gratuitous. The story didn’t need this turn to demonstrate her forbearance, strengthen her view that people need to act responsibly to recover after adversity, or deepen her empathy.

Exiting on a problematic note (The fourth season): I am relieved to report that Dr. Melfi once again accomplished some decent work with Tony in the middle episodes and, more importantly, was not made to suffer further major trauma or humiliation. I do think she made a major tactical blunder that was probably responsible for Tony breaking off treatment (again) near the end. He began experiencing feelings of grief after learning of the suicide of Gloria, a woman with a borderline personality disorder whom Tony had briefly had an affair with. He initially blames Dr. Melfi, who had attempted to treat this woman, and he becomes quite intimidating, charging across the office to stand, angrily, towering over his therapist. During a later session, as his continuing grief is heightened when a racehorse he loves is destroyed after severe burns in a stable fire, Tony tells Dr. Melfi that he feels like a “sad clown.” This unprecedented self description deserves pursuit. Instead, no doubt still rattled by Tony’s recent menacing conduct in the office, Dr. Melfi is dismissive and something of a scold, reminding Tony that, far from acting like a sad clown, he typically copes with sadness and other poignant feelings by taking aggressive actions. At their next meeting, in episode 11, Tony himself is now dismissive. He complains of having received little if any help since early control of his symptoms, and he insists on terminating treatment. This sequence of events in the therapy is entirely credible, even clinically astute. Thus discharged, Dr. Melfi exits the series at the generally estimable level she established in the first season. She’s not perfect by a long shot. Countertransference problems are apparent. She still seems oblivious to the fact that her skirts are often too short, but at least she hasn’t gone to bed with Tony. This is no small triumph: she may well be the first female therapist of an adult male patient in fictional film history not to cross the boundary into sex. She still often seems too hesitant, too tentative in her comments, though it can be argued that Tony could not tolerate a more authoritative approach, especially given his mother’s hardboiled, controlling style, which we saw for ourselves during the first season. Imperfect she may be, but Dr. Melfi still comes through as a dedicated psychiatrist, one who’s trying to do a good job with a patient many of us might deem untreatable.

Reduced to the margins (the fifth season): Tony returns for visits with Dr. Melfi in a couple of episodes, but except for one issue, the psychiatric subtext of the series nearly goes missing this season. We did learn that Tony's panic attacks actually began perhaps 12 or 13 years before the ones he experienced in the first season of the show. In fact it was such an attack that prevented Tony from joining his first cousin and boyhood playmate Tony Blundetto (a major figure in the fifth season, played by Steve Buscemi) for a heist job, so something of the sort. Without his cousin to help get the job done, Tony B. was arrested and spent the next 17 years in prison, for which Tony S. experiences considerable guilt.

The Piano Teacher,
adapted - from the novel by Elfriede Jelinek - and directed by Austrian Michael Haneke, is a brilliant study in the pathology of personality disorder, sadomasochistic perversion, longing, and desire. The central character is Erika Kohut (Isabelle Huppert), an accomplished pianist, and professor at the Vienna State Conservatory, where her specialty is the work of Schubert and Schumann. Single at 45, she lives with a mother (Annie Girardot) whose domination of her is difficult to overstate. Her life is barren, even tortured, but at least in stable equilibrium until she begins to receive the attention of Walter Klemmer (Benoit Magimel), a dazzling, sexy, multitalented young man, full of himself in the manner of attractive, successful 20somethings. He is aroused by and drawn to this woman, whose curious mix of haughty superiority, frozen manner, and half crazed vulnerability he finds irresistible.

Like any seemingly unattainable goal - climbing a treacherous mountain, for example, having Erika Kohut becomes Walter's principal objective. An engineering student, he is himself also a passionate pianist who signs up as Erika's student in order to pursue her. The ensuing story linking these three people - Erika, Walter and Erika's mother - should please Freudians, Reichians and more contemporary psychoanalysts alike in its explication of Erika's highly disturbed character. Wound tight, and tough as nails in her teaching, Erika's dominion over her students is as complete as her mother's control of her, as clear a portrayal as one might want of 'identification with the aggressor,' or simply identification with a same sexed parent no matter how twisted the model, or that inversion of the Golden Rule we sometimes speak of as 'parallel process' - do unto others as one has been done to.

Erika's ties to her mother are complex; how could they be otherwise? She loves her mother and is devoted to her, side by side with hatred of her mother for the relentlessly controlling, intrusive way in which she has ruined Erika's life. And of course Erika hates herself for passively allowing this situation to keep her in thrall. At one point in bed - significantly the women share the same bed, just as a mother and infant might, or female lovers - Erika literally jumps atop her mother in what is clearly an assaultive manner, but what she says is not "I hate you" but, to our surprise, "I love you!" No better illustration of the mental mechanism of 'reaction formation' will be found on film. While at the same time this scene expresses Erika's ambivalence, for she does desperately love her mother, even though the emphasis here must be on desperately.

Erika has no men in her life until Walter comes along. She frequents adult sex shops where she enjoys watching videos. She mutilates her genitals with a razor blade, presumably for sexual pleasure. She is interested in bondage and has a whole kit of ropes and chains tucked way under the couch in her room. Her response to Walter is to order him to enter into elaborate bondage and other SM practices. Freud would probably say that this is an example of the 'repetition compulsion' principle. She seeks control over the bondage into which her mother has placed her by becoming the initiator of her own bondage: she is to be in charge here with Walter, not like at home where mother is in charge of her. Neo-Reichians believe that the goal of masochism is not self punishment for guilt, nor is it to re-enact the pain visited upon them by abusive parents as a form of mastery of the old childhood situation. Instead, Reich and his disciple, Alexander Lowen, believed that masochists suffer from chronic, entrenched emotional shutdown: they do not feel their feelings. They cause themselves pain - by direct self insult or by provoking others to treat them harshly - in order to stimulate, to arouse, their own dormant emotions, as an elaborate if perverse strategy for restoring, even temporarily, an emotional life. As their intimacies begin, Erika tells Walter that she has no feelings. Later he tells her that she is incapable of love. It's true. She is only capable of using him as a device to work out her own demonic problems. He comes to understand this, the essential self-centeredness of her responses to him, or lack of them, when he says that her only goal has been to humiliate him, to rob him of his manliness, i.e., his right to express his love and his sex as he freely chooses, not as she orders.

Erika possesses an awful insight into her own warped nature. Early on after meeting him, she tells Walter that her father died in an insane asylum. She tells him later about the tragedy of Schumann's predicament, when he began to realize that he was aware of the direction in which he was headed. All three principals in this masterfully created film are outstanding. Magimel is everything a proud, energetic young man should be, and his responses to Huppert's character are well nuanced, richly complex, and entirely convincing. But Walter is no more than a foil for the elucidation of Erika's character, and it is Huppert who gives a crowning performance to her long career as an actress especially adept in quirky, dark roles, much like Charlotte Rampling, although more accomplished, less brittle, more far ranging in the nuances she is capable of portraying. This is an electrifying film experience. Cannes bestowed awards in 2001 here for best film, best actress and best actor. (In French with English subtitles).

Depicting schizophrenia poses major problems for a filmmaker, because its defining features are disorders of thinking and perception – symptoms that a camera can’t see.As an example of these problems, Ron Howard’s Oscar winning hit, A Beautiful Mind, is highly instructive.Mind dramatizes the life of mathematician John Nash (played by Russell Crowe), based on a splendid biography by Sylvia Nasar.Nash’s career was cut short by the onset of paranoid schizophrenia around age 30.But after decades of hospitalizations and campus wanderings, he has in late life regained his ability to do academic work and found a larger emotional capacity to care for his family.Aiding these happier developments, his early work on game theory was rewarded with a share of the Nobel Prize in economics in 1994.

Whether the filmmakers take excessive liberties with the facts of Nash’s life has been debated by some film critics (it is true that a number of important facts of his life are omitted or glossed over in the film version). What concerns me is whether they have taken excessive liberties in portraying schizophrenia.How does one film this disorder realistically?Three issues require attention: the manifest behavior of the schizophrenic protagonist, the inner psychotic experience, and the course and treatment of the illlness.Let’s examine how these issues are dealt with in Mind, starting with treatment and course.

Nash’s first breakdown occurred in 1959, when he was recently married, about to become a father, and engaged in his first job after university graduation.Not told in the film was the fact that Nash already had a son by another woman whom he had abandoned.First breaks often occur during developmental crises, and this surely was one.He was admitted to the McLean Hospital (it has another name in the film), where he received Thorazine and insulin convulsive treatments, both common antipsychotic treatments in the early 60s.Nash’s symptoms resolve, but later, as an outpatient, he stops his maintenance Thorazine because it clouds his thinking and reduces his libido; both are common side effects.He relapses and must be court committed.His delusions become entrenched and systematized.Missing from the film is information that over the next 10 years Nash required several more involuntary hospital episodes.Nasar also informs us that after 1970 Nash refused to take antipsychotic medications.Instead, as the film suggests, he avoided rehospitalization by gradually developing the will to disregard or intellectually reject his psychotic delusions.This is a plausible strategy using principles of cognitive psychotherapy, although such efforts require a level of mental rigor which few persistently psychotic patients possess.For at least the past 10 years, Nash has apparently achieved a stable remission without treatment; this form of “spontaneous” remission does occur in perhaps 10 to 20% of cases.

Regarding Nash’s conduct in the film, Crowe performs admirably.Prior to the first psychotic episode he is socially hesitant, unable to make small talk, often tactless, obsessively preoccupied with his studies, sometimes unkempt.These are all common pre-psychotic personality features for many schizophrenics, especially men, and are behaviors well documented in Nash’s case by Nasar. Once in the throes of his psychosis, he becomes frenzied with obsessive, delusion-driven activity, stays up nights, looks haggard and disorganized.When arguing with voices on campus he is agitated, shouting and pacing about.All of this conduct rings true.Some critics have complained that Crowe does not clearly articulate inner emotions like fear, or that he lacks charisma. Such criticism betrays the critics’ lack of clinical knowledge.They want him to be socially attractive and emotionally expressive like a good neurotic, when in fact schizophrenics often have great difficulty accurately expressing emotions in ways others can fully understand and empathize with.At every turn Crowe evokes his character convincingly.It is an impeccable performance.

What about the representation of Nash’s psychotic experience – his inner world of delusional beliefs and hallucinatory sensations?This is the aspect that trips up the most earnest filmmakers who wish to portray schizophrenia or allied conditions honestly.Some very wisely decide to rely solely on the schizophrenic character’s manifest behavior and quirks of speech that may suggest a disorder of thinking processes, and make no attempt to represent their inner experiences (think of Geoffrey Rush’s manic but disorganized conduct in Shine, Janet Margolin’s clanging speech in David and Lisa, or Robert Duvall’s brilliant wordless cameo as the shy Boo Radley in To Kill a Mockingbird).Others employ surreal artistry or magical realism to suggest bizarre inner experience (for example, Salvador Dali’s scenes of the protagonist’s fugue experiences in Spellbound, or Angels of the Universe, an Icelandic film about a schizophrenic man who, while acutely psychotic, walks on water like Christ). Ron Howard indulges in some of this sort of thing, using visual gimmicks meant to represent some of Nash’s delusional insights.

But surrealism misses the mark.The problem lies in the nature of the symptoms: complex, outrageous thoughts (delusions) and false perceptions (hallucinations).The latter include voices, typically disembodied from visual human forms and emanating from the spatial hemisphere behind the patient, odd tactile sensations (often sexual), and unpleasant odors.Visual phenomena tend to be shadowy, ill formed, darkly diaphanous.How on earth is a filmmaker to get such things down for the viewer to see?The only realistic (but very limited) means is to show the behavioral correlates of these experiences.

Schizophrenics often subvocalize their auditory hallucinations – the voices they hear - and so they may murmur.One may see lip movement, hear subvocal sounds, or see patients turn their attention to the space behind them where the voices seem to originate.I have yet to see an actor use such behaviors to suggest hallucinations.Howard does have Nash (Crowe) draw a crowd on the Princeton campus when he agitatedly argues with his voices: this is a highly believable scene.One can also demonstrate the products of delusional thinking, and this Howard also does well, when he shows us whole rooms full of pasted up articles with garish connecting lines and circles in red ink, the outpourings of Nash’s deluded convictions that media articles contain secret coded messages.

Howard uses another more controversial strategy as well: he dramatizes Nash’s delusional beliefs and auditory hallucinations, representing them in the form of several vivid individuals and vignettes in ordinary (“real”) scenes.This is done without providing any cues for the audience.We see these people repeatedly interacting with Nash, but from our perspective, well into the film, we think that these fantasized people and events are real.With this device Howard puts the viewer in Nash’s shoes; not only is he convinced, but we also are convinced, of the reality of certain characters and circumstances that later prove to be merely Nash’s crazed imaginings. And of course we, like Nash, are incredulous when first confronted with the fictitious nature of these psychotic props.(When Nash’s psychiatrist – played by Christopher Plummer -first appeared, my partner believed he was part of the conspiracy against Nash.)Nice manipulation.

But this tour de force is purchased at the price of portraying schizophrenic experience dishonestly.Schizophrenics do not have vividly real, lengthy visions that look like objective reality.Their visual hallucinations are shadowy, the voices are disembodied, and the delusional thoughts – sometimes infinitely complicated – can occur without any accompanying imagery at all.Complex life-like scenes do occur in so-called “lucid dreams,” partial complex seizures, delirium and hysterical hallucinations.But not in schizophrenia,

This inauthentic dramatization of schizophrenic hallucinations is very much at odds with Crowe’s clinically solid conduct.Does it cause the film to fall short in informing an audience about this devastating disorder?Well, yes and no.We see, through the devices used in the film, that, for the patient, delusional and hallucinatory experiences are reality at times.And that is a terribly important idea for the public to grasp.Unfortunately, the means that Howard uses to drive home this point involve clinically invalid portrayals of schizophrenic experience.I wish I could think of a better way.

Add: For a more fact based, though still selective, account of the life of John Nash, see ABrilliant Madness (Mark Samels, US, 2002), a one-hour documentary produced for PBS, featuring interview segments with John and Alicia Nash (who recently remarried after a 35 year long divorce), Nash’s sister Martha, Nash biographer Sylvia Nasar, and various friends. And for a far better depiction of a schizophrenic man, check out David Cronenberg's recent film, Spider.

Divided We Fall, written and directed by Jan Hrebejk, is one of several fine recent films from the Czech Republic. It is set in a Bohemian town during the Nazi occupation. The opening credits are imaginatively accompanied by brief visual vignettes, each labeled by year. The first (1937) shows a car stopping along a country road so that the four men traveling in it, all good friends, can take a leak. We glimpse among them David Wiener, son of a prominent Jewish family; Josef Cizek, a Czech townsman; and Horst Prohaska, a German national with Bohemian roots who married a local woman. Horst is left behind temporarily when he can’t get his fly zipped. Next it is 1939, and Jewish properties are being confiscated, with Horst in charge. Then it is 1941: swastika banners are draped everywhere, Nazi troops are in evidence, Jews are wearing Star of David badges, and all of them, David and his family included, are leaving on a train to somewhere.

After the last credit, the film story commences, in 1943. It is dark and we see an emaciated, fugitive David sneaking through the streets. He spots an older man, a former acquaintance, and asks for help. This man is terrified, tells David everyone on their block will die if he is seen there, and runs off toward a German soldier on a motorcycle yelling, “Jew, Jew here!” (The German doesn’t hear him and drives off.) Cut to the comfortable apartment of Josef and his wife Marie. Josef (Boleslav Polivka, a film celebrity in the Czech Republic) is a sardonic fellow who has been on disability since a compound leg fracture left him gimpy. The Cizeks are often visited by Horst (Jaroslav Dusek), their friend and benefactor, a buffoon who farts loudly, cracks his knuckles, and blows with the political winds. The winds of the moment have blown him to a prominent position in the local puppet government. He plays up his German origins and shaves his moustache to resemble Hitler’s. Horst genuinely likes Josef and is even more fond of Marie. He showers them with fine foods and liquors available only to the Nazis and their stooges. One night Josef encounters David in an alley and ends up taking him in. It is a fateful decision because, once David is protected by them, even if he subsequently flees, chances are that Josef and Marie’s duplicity will be found out and they will be killed. But even failure to report the brief alleyway contact would have the same consequences.

Damned either way, they decide that David should stay.The film’s main dramatic tension is provided by numerous close calls during Horst’s visits, when David’s presence is nearly discovered. Some of these encounters are also very funny. Horst is a terrific character invention for sustaining the tragicomic atmosphere. His buffoonery is hilarious. But he is also a seriously loose cannon. There is no predicting what he will do, whether his conduct and judgment will be motivated primarily by his loyalties to his old friends or to his new overlords. Nor can we ever be sure just how dull or unperceptive he is. Horst’s presence thus assures constant tension, and, in this regard, he functions like the character Blackie in Emir Kusturica’s Underground, although it is a crazed emotional volatility that makes Blackie both funny and dangerous, not his moral shiftiness. Horst in time does prove to be a more complicated and perceptive fellow than his manifest boorishness would lead one to assume. He grows in stature through the film, as does Josef, who moves from disconsolate, self-pitying layabout to resourceful activist. The story moves along at a brisk pace and is entirely absorbing.

This film raises again an issue that surfaced in discussions of Roberto Benigni’s acclaimed 1998 film, Life is Beautiful. Is it morally or, for that matter, artistically defensible to poke fun at the Holocaust? Many people worldwide loved that film, but my partner and I were both troubled – actually we were quite offended – by its conceits. And we weren’t alone. David Denby, film critic for The New Yorker, observed, first of all, that Nazism coopted the fantastic and annihilated humor and hope. The system was designed precisely to do so. And for that reason, Denby suggested, Life is Beautiful, by the manner in which it lightly employed humor to trivialize, and even defeat, oppression, tells a story that is so unlikely to have occurred, so contrary to the historical record, that its very portrayal can be viewed as an affront to fundamental values of honesty and humanity in art.

I think a similar charge can be lodged against Radu Mihaileanu’s 1999 film, Train of Life, in which the population of a rural shtetl somewhere in eastern Europe deck out a fake deportation train to smuggle themselves out of reach of the Nazis. Where Life is Beautiful is driven by Benigni’s trademark showboat slapstick, Train of Life is played principally for broad ethnic humor. But neither film conjures threat or suspense. They both fail to meet a requisite standard of realism, and this renders the humor in them difficult to swallow. In contrast, Kusturica’s Underground, although it concerns not the Holocaust but the oppression of Yugoslavians during WWII and beyond, serves to illustrate the point that over-the-top farce can be used successfully to depict the horrors of war, if realistic suspense, anguish and loss also find their way into the story.With these comparisons in mind as yardsticks, how does Divided We Fall measure up? Very well indeed, I think. As for realism, it is true that the Cizeks seem to live more comfortably than I imagine most folks did toward the end of the war. There is always plenty of food on hand, even after Horst ceases to visit them frequently. Nevertheless, the basic story of people hiding a Jew away from the Nazis is entirely realistic: it happened often, even in Berlin. Moreover, the film does convey a sense of danger lurking at all times.The comedy in this film is far darker than in Life or Train. The gags are always posed ruefully and with a tense, high stakes, life-and-death edge. For example, Horst tries to coach Josef to master a bland, vacuous facial expression, to mask his natural bent toward irony and subtle arrogance, in order not to provoke Nazi attentions (Josef retorts that it’s easy for Horst, for he was born with a vacuous expression).

Even in the closing, wildly improbable scenes, as things get zanier by the minute, we can never be sure what fate will ultimately befall Josef, Marie and Horst. Slow motion filming creates blurry images at times, and these are also used to good advantage. Example: during a scene when Josef grabs Horst and swings him round and round in a silly dance that distracts Horst from discovering David hiding in Marie’s bed. The blurry dance images suggest angst and thus counter the farcical aspect of the scene. For me, this film easily passes Denby’s test: because it always juxtaposes realistic threat with the humorous moment, Divided We Fall does not violate fundamental values of honesty and humanity in art.

“Humor is odd, grotesque, and wild, Only by affectation spoil'd; Tis never by invention got,

Men have it when they know it not.” ...Jonathan Swift

“...comedy, like lunacy, is the expression of the unaccomodated man.”

...Robert Brustein

Surely there is no more elusive goal in filmmaking than the creation of a good comedy.Much of what passes for humor in the movies these days is forced, trite, infantile, boring, barely fit for grade schoolers, like the 1994 film, Dumb and Dumber, or for early adolescents, like most films by the old “Saturday Night Live” gang.A few passing yuks, nothing more.Swift got it right: trying too hard to make things funny usually doesn't work.

Specifying the elements that add up to good humor is just as daunting a task as creating it.For one thing, the landscape of comedy is incredibly broad, stretching from the understated wit of manners and place, through farce, romantic comedy, the zany physical comedy of slapstick, to rueful, ironic comedy, the extreme of which is dark, so-called “black” humor.

One's comic film favorites are sometimes based on a personal connection with certain situations or characters.One reason I never tire of the 1986 high school comedy, Ferris Bueller's Day Off, is because the thoroughly miscreant principal is so much like one we had: a plethoric, irascible, bullying toad of a man who regularly told us at assemblies that the sole purpose of attending Theodore Roosevelt Junior High School was to “learn to mind our own business.” He kept all us kids in stitches.Beyond the purely personal, what makes a film funny?Wit helps, of course.Eric Rohmer's sex farces are widely appreciated, largely for their witty conversations, although they can drag on.Physical comedy generally plays better on screen, for it is so immanently photographable.This helps account for the perennial appeal of the films of Buster Keaton, the Marx Brothers, Jacques Tati, and Jim Carrey.

Another key element in humor is, as Brustein suggests, its link to the darker, more troubled side of human nature.George Orwell once said that the aim of a joke is not to degrade the human being but to remind him that he is already degraded. The best of humor often emerges as a sort of dialectical response to, or reflection of, our foibles, faults and suffering, the tragic side of life.Think of Chaplin, whose great comedies turned on stories of his plucky battles against such problems as privation, handicap, or man's enslavement to the machine.Woody Allen has for years mined the humor in a more contemporary vein: our neurotic conflicts and inward suffering.

Black humor takes Orwell's idea to its outer limits, finding the comedic - through the use of irony, paradox, physical comedy, and any other means at hand - in the most dire and perverse of human circumstances.Consider as examples these two great antiwar comedies:Stanley Kubrick's 1964 masterpiece about American militarism in the Cold War, Dr. Strangelove or How I Learned to Stop Worrying and Love the Bomb, and Emir Kusturica's kaleidoscopic 50 year history of Yugoslavian violence, Underground (its hero is even named “Blackie”).This is the comedic turf - the "...odd, grotesque, and wild..." in human nature - where Swift treads.

If Swift were here today and chose a film to illustrate his view of humor humor, I think that film might be Funny Bones.*In this enquiry into the nature of comedy, Oliver Platt plays Tommy Fawkes, a standup comic struggling to follow in the footsteps of his famous comedian father, George (played by Jerry Lewis).After a disastrous Las Vegas debut, Tommy flees to Blackpool, England - where George grew up and got his start in show business - in a desperate effort to learn the art of comedy by exploring his roots.There he discovers his father's long ago lover (Leslie Caron) and their son, Tommy's half-brother (the extraordinary English physical comedian, Lee Evans).The two could not be more different: Tommy tries so hard and fails, while Evans's character cannot stop himself from being funny.As George (Lewis) says, once he has caught up with Tommy in Blackpool, if you've got it, you've got it....you've got “funny bones.”

Comedic arts are cleverly surveyed in this movie: vaudeville, circus comedy, slapstick, animal acts, mimickry.But dark, even sinister, humor is at the heart of the film.It begins with murder on the high seas, and another killing is seen later in flashback.The juxtaposition of humor with violence and troubled love is deeply etched here, especially in Evans's role.And in the (literally) over-the-top finale, when Tommy has for the first time entirely abandoned himself - to danger and to his performance - he and the viewer get the idea that it is through surrender to that which is odd, grotesque and wild within us that the farthest reaches of comedy can be accessed.

Well, all of this is fine as far as it goes, but still we are left with a bundle of questions.What makes wit witty?What alchemy transforms violence into hilarity?By what tricks - artistic and intrapsychic - is humiliation at our faults short circuited to humor?Is it any more than the nervous defense of reaction formation: whistling in the dark, our dark?I can't resist paraphrasing Justice Stewart's famous comment on pornography:'I shall not attempt further to define comedy...but I know it when I laugh.'_________________

* Funny Bones was written and directed by the English filmmaker, Peter Chelsom.First screened at the 1995 Sundance Festival, it was poorly promoted thereafter by Disney Studios, which couldn't figure out what sort of film it was, and so it received almost no theater exposure.It is available on video.

I found the recent hit movie, The Hours, to be an unwieldy, dissatisfying film. The dual themes of women’s special strengths and vulnerabilities – themes at the core of both of the novels that presumably inspired this film – seem to have been set aside in favor of a more one-sided meditation on emotional fragility and suicide. The screenplay was adapted from Michael Cunningham’s 1999 Pulitzer Prize winning novel, “The Hours,” in which he presents stories of three women in different eras who are affected in some way by Virginia Woolf's 1925 novel, “Mrs. Dalloway.” The latter describes a socially prominent woman’s activities and reflections over the course of a single day, as she prepares to host a party. Reveries of loves and losses long ago, and other events, intrude upon her party planning and present day concerns about the people foremost in her life. Almost without exception in Woolf’s novel, it is the women who are strong, the men weak or damaged. Clarissa Dalloway’s occupation is arranging the innumerable details that taken together affect the quality of daily life – food, clothing, flowers, conversation, parties, the fabric of gaiety and beauty in living. Even though Woolf personally eschewed living such a life, she discerned Clarissa Dalloway’s strength, sensed its chief downside - a fearsome and somewhat precarious solitude, and saw also that her character’s social activities were important, not frivolous. Each of Cunningham’s three stories also unfolds over the course of a single day, a day upon which each woman is also planning a party. And, like Woolf, Cunningham seems to appreciate the strength and complexity of all three women.

The first story in The Hours concerns Woolf herself (Nicole Kidman). The film opens with brief scenes leading to Woolf’s suicide in 1941, but soon flashes back to a day in 1923 when her sister, niece and nephews are coming to visit. It is also the day she first begins writing “Mrs. Dalloway.” Woolf had by then suffered several episodes of psychotic depression and had made two suicide attempts. To reduce the stressfulness of her life, at her husband Leonard’s urging, the couple had moved away from London to Richmond, a quiet town in Sussex. Woolf is miserable here, entirely out of her element. In a confrontation with Leonard after her relatives leave, she tells him that if returning to London means she might die as a consequence of the stresses of that lively place, she prefers this path to the deadly boredom of Richmond.

The second story concerns Laura Brown (Julianne Moore), an unhappy suburban Los Angeles housewife who is pregnant with the couple’s second child when we meet her in 1951. She was a misfit in high school, a loner on the sidelines, and now she feels unsuccessful as a homemaker and mother. Laura is struggling to prepare a cake for her husband's birthday and is also on the verge of suicide. She’s just begun reading “Mrs. Dalloway,” and the novel seems to have a redeeming effect upon her, helping her to resist self destructive impulses. The third story is set in New York City in 2001. Clarissa Vaughan (Meryl Streep) is a successful book editor who has maintained a stable lesbian relationship for 10 years. Much earlier, though, she had had an unforgettable affair with a man, a writer, Richard (Ed Harris), who left her for another lover, a fellow named Louis. Richard is now alone, dying of AIDS. Clarissa is his primary caregiver, visiting daily, bearing food, flowers and support. For years he has nicknamed her ‘Mrs. Dalloway’. We follow Clarissa Vaughan’s day as she plans a party to honor Richard, who has just won a major poetry prize. He will not live to attend the event.

If this all seems overly complicated, it does not play that way. The film is well crafted, with scene changes that seamlessly move us to and fro among the three women’s stories. But the acting seems uneven. I think Kidman is brilliant as Woolf; her performance ranks among her best efforts. Harris is also quite riveting as the failing but still fierce Richard. The other two principals – Moore and Streep – offer somewhat beclouded turns. Streep’s Clarissa is emotionally unpredictable, unfathomable at times. Moore’s Laura is even more difficult: her incessant misery remains largely incomprehensible. She impulsively dumps off her young son with a sitter and rushes to a hotel where she intends to commit suicide by an overdose of pills. Causes for her suffering are unclear, compromising empathy for her. Whether she’s suffering from major depression or plain emotional incontinence isn’t clear. What, besides the theme of suicide, ties these three stories together? All three women, like Clarissa Dalloway, felt inordinately lonely. Each knew something of homoerotic allure. Each knew of love and loss, perhaps, though actually I’m not so sure how much capacity for love Laura Brown possesses. Yet in spite of several interlocking themes and seamless scene changes, the stories here don’t fit in easy harmony. Why not?

I think the reason for disharmony is that in the film the strengths of all three women are diminished when compared to Cunningham's novel. Woolf is made to seem willful and irrational in her desire to return to London, for the film does not indicate her important role in the literary society of Bloomsbury, a role that not only fed her own appetites but importantly influenced others in her literary circle. In the book it is Richard's former lover, Louis, who breaks down in tears when he comes to visit Clarissa Vaughan, while in the film it is Clarissa who has an unexpected emotional meltdown when Louis visits. Why this change? The starkest contrast between book and film is in the character of Laura Brown. Cunningham associates Laura's misery with the fact that she was an ethnic minority bookworm in high school who was so flattered by a marriage proposal from a returning WW II military hero that she impulsively accepted this opportunity for a conventional life. The result is her entrapment in a suburban housewife’s role that she finds thoroughly unsuitable. More importantly, in the novel Laura is never suicidal. She reflects on suicide briefly as she reads Woolf, but she checks into a hotel for respite, takes no pills along, has no plan to overdose there, as in the film. Brown should sue the screenwriter for defamation of character.

A film adaptation should be judged on its own artistic merits. But it is still fair to wonder why the filmmakers chose to pathologize these women. Especially when portraying each of them as stronger – in just those instances I have described above - would have entailed no additional costs or structural complexities. One answer is simply that they chose instead to play up the theme of suicide. Cunningham does invite this, I suppose, by opening his novel at the moment of Woolf’s suicide, and Woolf also creates a suicide in her novel. But the suicide of Septimus Smith in “Mrs. Dalloway” conveys a then-timely metaphorical meaning: the sacrifice of young men in the recently ended Great War. Another possibility is gender bias: the (British male) filmmakers may view these women from a traditional male perspective that tends to discount their strengths. I recently discussed this question with an American woman, a corporate executive who has worked with American and British counterparts. She says the Brits have a harder time accepting her station than her countrymen do. Hmmm. The changes could also reflect a more knowing, commercially driven decision, i.e., to pander to conventional, traditional gender stereotypes in hopes of broadening the film’s box office appeal.

So much can happen in a day, especially within one’s thoughts. Moment-to-moment human experience is especially burdensome when one is suffering emotionally. Then time can hang heavily. In the state of unspeakable dysphoria that can befall a person with mental illness, simply carrying on from morning to night may be an almost insurmountable task. Woolf knew this, and so do the fictional characters, Laura Brown and Richard the poet. When the strengths of Cunningham’s Woolf, Brown and Vaughan characters are considered in balance with their solitude and suffering, however, "hours" can also be regarded as a measure of something positive, of activities of enormous importance in all our lives, rather than only as a metric for the morbid burden of time hanging heavily on troubled souls. Too bad this more positive theme went missing in the film.

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The perspective in this review owes much to a critique of the film by Daniel Mendelsohn, “Not Afraid of Virginia Woolf,” which appeared in the New York Review of Books, March 13, 2003, pp. 17-20. The Hours was written by David Hare and directed by Stephen Daldry.

From 1982 to 1985, while Steve James was attending film school in southern Illinois, he volunteered in a Big Brother program and was assigned to spend time with Stephen Dale (“Stevie”) Fielding, a disadvantaged grade school boy. They lost contact when James moved on to Chicago to make such films as the acclaimed documentary, Hoop Dreams, and the docudrama, Prefontaine. Feeling that he had not lived up to his pledge to Stevie to maintain contact, James reached him a decade later, in 1995, and gained consent to film their renewed relationship over the next couple of years. Plans changed in 1997 when Stevie, himself a childhood sexual abuse victim, was indicted for sexually molesting an 8 year old girl he was babysitting. He confessed. The focus of the film became unavoidably altered and protracted by this event and its aftermath. In the resulting documentary, simply titled Stevie, James follows the arduous events of the next few years, culminating in Stevie’s sentencing to a 10 year prison term in 1999.

One Internet reviewer has called this film a waste of time to make and a bore to watch, not because it was badly made but because Stevie Fielding is a "rural poor white trash...loser" whose story does not merit anyone's attention. Wow! I'm glad that fellow wasn't reviewing manuscripts the day Dickens dropped off "Oliver Twist," and that he wasn't in charge of funding decisions when Frederick Wiseman needed cash to make Titicut Follies. Like many disadvantaged, traumatized kids who develop a pattern of misconduct, Stevie can perhaps be easily classified as a loser. His record, even apart from the molestation, is indeed sordid: burglary, assault, drunk and disorderly, fights, credit card fraud – you name it. He only learned the identity of his father recently. He hadn’t worked in over 4 years before his sentencing. He has few supportive or constructive ties in the family or to the community. But he does have a devoted fiancée, Tonya, whom we meet. She is an endearing woman who seemingly suffers from some sort of developmental disability.

This is a long (144 minute) film. The original plan had been to focus exclusively on Stevie in his early 20s. James had not planned be on screen himself at all. His presence emerged spontaneously during filming; i.e., gradually the relationship between James and Stevie became the focus, rather than Stevie as an individual character. Unlike the narcissistic Michael Moore, when James is on screen he does not ham it up or try to influence the viewer through self-aggrandizing polemics and stunts. He just soberly says what’s on his mind. James is obviously troubled by the mess that Fielding has made of his life. He may believe that their 10 year disconnection contributed to Stevie’s deepening problems, although that question is never openly confronted. James and his wife, who is a professional counselor, try to be supportive and helpful, but events after 1997 have a gravity and momentum that tend to sweep aside and render nearly useless any efforts that the Jameses, Tonya or others can make to influence Stevie’s fate. The judge said later that he would have decreed a lesser sentence (6 years) had Fielding expressed remorse for the crime. Instead Stevie refused the judge's invitation to speak and made no statement at all. At the time the film wrapped, he had served over 3 years of his prison term.

Critical response to the film has been varied. It got strong praise from several reviewers after screening at the Toronto Film Festival two years ago. According to one of the producers, when it screened later at a documentary festival in Amsterdam, it was criticized on ethical grounds. Some people thought that James had exploited a marginal young man in circumstances when he was especially vulnerable. They argued that instead of continuing to shoot, James should have cast aside his camera and more vigorously resumed his earlier private role as a supportive figure in Fielding’s life.

The film is reasonably well crafted, although it could have been more tightly edited and thus briefer and possibly more engaging. While James is honest in his enquiry, it does concern me that naïve viewers might form unnecessarily pessimistic generalizations from the film about the fate of troubled, delinquent young people. Although men like Stevie may continue a pattern of antisocial behavior into their 20s and beyond, some change later on, in their 30s and 40s, especially if they find a loving, steadying partner like Tonya. This sort of outcome was not uncommon, for example, in the famous lifespan study of delinquent inner city boys in Boston that has been conducted since 1940, the project begun by Sheldon and Eleanor Glueck and led more recently by George Vaillant.

But this film is as much about James and his Big Brother role as it is about Fielding. And as such it can also be viewed as a morality tale about the vicissitudes of liberal gestures of doing good. If you really want to be a Big Brother, James raises the question of whether you should be prepared to stay the course and never walk away, as he did. In for a dime, in for a dollar. That seems a very tall order indeed. Or should one draw the opposite conclusion, that Big Brother-type programs are fatally flawed in their very conception, promising more than they can reliably deliver? Somehow, when James tells Stevie near the end that he "will be there for him," my reaction was that, while James was undeniably sincere, his phrase still rang hollow, seemed reflexive, i.e., it was the 'right thing to say,' rather than being a solid confidence builder delivered from the heart. Did James’s assurance mean anything to Stevie? Can it be trusted? Will it matter? This film raises troubling questions. Perhaps that will be its lasting value.

A few months ago I again sat spellbound watching Geoffrey Rush’s stunning portrayal of the Australian concert pianist David Helfgott in Shine, the1996 film based on Helfgott’s life. Helfgott was a child prodigy who became psychotic in his early 20s while studying in London, passed the next dozen years in and out of mental hospitals, then began a slow and steady musical comeback, finding in middle life the success, if not quite the emotional stability, that had eluded him as a young man. It is a remarkable story, and Rush’s grasp of Helfgott’s malady is astonishing: a schizoaffective illness with predominant symptoms of barely controlled mania and schizophrenic thought disorder. Rush nailed an intricate admixture of behaviors - rapid, flighty speech; quirky mannerisms such as a stereotypical forced “ho-ho” laugh; an infectious if highly edgy charm; fervent night and day music making; provocative sexual behavior; a penchant for slovenliness; disorganized thinking to the point that he could not compose a letter to an old teacher without assistance - in such an exquisitely authentic manner that I was able to make the correct diagnosis the first time I saw the film in 1996, knowing nothing about Helfgott. (I read a piece a few weeks later in the New York Times by a Yale psychiatrist who had verified the diagnosis of schizoaffective disorder in a conversation with one of Helfgott’s psychiatrists in Melbourne.)

All too often, American film depictions of psychiatric disorders are fanciful: they may be entertaining but tend to be clinically invalid. Recent examples include Jack Nicholson’s OCPD character who turns cuddly in As Good As It Gets, Jim Carrey’s bogus schizophrenic in Me, Myself and Irene, the misleading picture of adolescent suicide offered in The Virgin Suicides, and the spurious dramatization of schizophrenic delusions in A Beautiful Mind. Such depictions are doubly annoying because they are unnecessary - authentic portrayals can be as dramatically forceful as fraudulent ones - and because they foreclose opportunities to edify audiences about the realities of mental illness. Mental disorder is off the radar screen of America’s largest film market, teenage and young adult moviegoers, and the Hollywood brass who serve up the products kids buy.

There are noteworthy exceptions. Among them are Robert Duvall’s two extraordinary cameos in the early 1960s: his film debut as the schizophrenic Boo Radley in To Kill a Mockingbird, and as a war combatant with acute PTSD in Captain Newman, M.D. Gena Rowlands was clinically convincing in the throes of a manic episode in John Cassavetes’s 1974 film, A Woman Under the Influence. Dustin Hoffman did a fine turn as an autistic savant in the 1988 film, Rain Man, and, that same year, Michael Keaton gave an excellent performance as an arrogant cocaine and alcohol dependent bizwhiz in Clean and Sober. Timothy Hutton (Ordinary People,1980) and Winona Ryder (Girl, Interrupted,1999) each conveyed a convincing picture of adolescent depression.

If authentic portrayals of mental illness in American movies are few and far between, in contrast, wonderful portrayals are coming from northern Europe these days. Regrettably, most receive limited distribution in the US, if any, and often they appear only at film festivals. A few eventually do find their way to the video rental shelves. Here are six released just in the past few years that are worth searching for. Besides featuring a stellar portrayal of mental illness, these films also emphasize the interactions of these characters within family and social contexts. In A Song for Martin (directed by Bille August, Sweden, 2002), Sven Wollter plays an acclaimed composer who develops Alzheimer’s dementia. Wollter’s performance is clinically breathtaking. He displays with uncanny accuracy such features as woodenness of movement, a vacant stare, catastrophic responses, and gradual loss of personhood. This film depicts Alzheimer’s and its impact on loved ones in a far more comprehensive manner than the more popular recent film, Iris.

Pauline and Paulette (Lieven DeBrauwer, Belgium, 2002) tells the story of Pauline, a 66 year old woman who is developmentally disabled, a role played to perfection by Dora van der Groen, considered to be Belgium’s most accomplished film actress. After Pauline’s caretaker - a spinster sister - dies, new arrangements must be made by the other two surviving sisters, neither of whom is very keen on taking in Pauline, a childlike, dependent sort who also wanders and needs assistance with her ADLs. Aberdeen (Hans Petter Moland, Norway/UK, 2001) is an unusual road movie that paints a compelling portrait of alcoholism and drug addiction, and the efforts of a family to reconcile in the face of such problems. Stellan Skarsgard, as the end-stage alcoholic father, and Lena Headey, as his estranged, cocaine addicted daughter, both offer stirring performances.

A Place Nearby (Kaspar Rostrup, Denmark, 2001) is a taut murder mystery that revolves around an autistic young man (Thure Lindhardt) and his protective mother. Lindhardt’s performance is quite believable, and the relationship between his character and the mother is explored with depth and sensitivity. Angels of the Universe (Fridrik Thor Fridriksson, Iceland, 2001) is the only fictional feature film I know of that uses as its otherwise unadorned storyline the development, course, and outcome of a young man suffering from a schizophrenic illness. Apart from a gratuitous touch of magical realism here and there, the sad story of Paul is altogether realistic, typical of the life trajectory of many young adults afflicted with this disorder. A Canadian film, Spider (David Cronenberg, 2003) rounds out this superb group. Here Ralph Fiennes offers a strikingly accurate portrayal of a man suffering from uncontrolled chronic schizophrenia; his performance and the film put A Beautiful Mind to shame.

What inspires actors to render such clinically accurate performances? Was there a relative or friend close at hand who had a similar disorder? Do they watch documentaries on mental illness or consult with psychiatrists? In the case of Song for Martin, Bille August adapted the screenplay from an autobiographical novel by the Swedish writer Ulla Isaakson, which may have provided a useful description of Alzheimer’s. Lieven DeBrauwer says that he drew upon childhood memories in creating the character of Pauline. Perhaps he knew someone like her and could coach van der Groen accordingly to realize her character. Geoffrey Rush offers the most revealing account, discussing the resources he relied upon for his role in Shine. By coincidence, he lived near the Helfgotts and befriended them, studying David Helfgott’s speech and movements. He also says that he drew upon his experience in miming. Whatever the talents and cues used by Rush and the other actors mentioned here, one feels indebted for their splendid work, inviting honest glimpses of mental illness while entertaining us so well.

Two realistic films show how some elements of opiate addiction, including the will to recover, may be similar the world over, while factors like family influence and the treatment process can differ enormously between cultures. Quitting, a 2002 film directed by Zhang Yang, dramatizes the true story of Jia Hongsheng, a Chinese actor whose early career success was sidetracked by drug dependence. His problems began in 1992 during a stage production that was being directed by Mr. Zhang. Mr. Jia’s addiction went on for 4 years, and he dropped out of acting. Things culminated when his family arranged for him to be hospitalized for a year of treatment. Later Zhang invited Jia to participate in a film about his addictive experience, and Jia agreed. Quitting is the result. Jia, his parents and his sister all take part, playing themselves.

The story centers on family disruption brought on when Jia’s parents move in with him and his sister in Beijing, in the midst of his addictive woes. Conflict is especially keen between Jia and his father, also an actor, who has just retired to aid his son. Old Jia has an addictive problem of his own, alcoholism, and having time on his hands increases his thirst. Young Jia is mercurially changeable: morose one moment, argumentative the next, and at times apparently psychotic (he claims to see a dragon out in space coming for him). His drug use is vaguely described; one can only be certain that he smoked pot and a lot of heroin. On his 29th birthday, young Jia forces his dad to drink more than usual, then insults him, even slaps him around. That’s the last straw for the family, who have police take young Jia away.

In the hospital he is placed on a ward with chronically mentally ill patients (all apparently actual patients), rather than on the drug unit, where his best buddy, who also shoots heroin, winds up. The hospital staff, also supposedly the real thing, seem amateurish and superficial in their manner of evaluating Jia. Intractably belligerent toward staff, he is finally restrained after striking out at a nurse one day, and this humiliation seems to trigger some sort of epiphany. He promises to behave if freed from restraints and spends the next night asleep in a fetal position. From that point on he remains steadfastly cooperative and pleasant with everyone. After a year he returns home to a happy family reunion.

This movie seems more like a 1950s mental hygiene film than a realistic drama. It lacks the sophistication one has come to expect in Chinese cinema, and is a far cry from Mr. Zhang’s excellent earlier film, Shower, which also concerned a troubled father-son relationship in the context of cultural change. But there are some truths here. One point of realism is that Jia’s early success went to his head: he’s arrogant and well off but lacks self discipline. Once he’s into drugs, a downward spiral ensues. This is not an unfamiliar story among young entertainers in the West. The film’s moral didacticism may serve the government’s aim to step up efforts against China’s major substance abuse problems.

The picture here of smoking heroin is also accurate. This method of using brown tar heroin was first evident in Shanghai in the 1920s and eventually spread to Hong Kong and then the West, from the 1950s on. Heroin is heated on aluminum foil over a flame and the vapors inhaled. Sudden deaths after such smoking have been attributed to some toxic product created when heroin and aluminum are heated together. Curiously, in light of Jia’s apparent hallucinations, this method of heroin use is referred to in China as “chasing the dragon.” But Jia’s conduct on drugs more befits someone abusing stimulants like cocaine or methylamphetamine, not heroin, which is far more inclined to leave someone sedated rather than crazy.

I recently revisited Gus Van Sant’s 1989 film,Drugstore Cowboy. Set in Portland, it is one of the best films ever made about junkies. Clever plot structure, fine acting, clinical authenticity and a fair measure of humor make this an absorbing film, free of the unmitigated grimness that weighs down most junkie movies. Bob Hughes (Matt Dillon) heads a junkie gang who steal prescription drugs from pharmacies. They prefer to shoot clean stuff, like the highly desirable “D” (Dilaudid), or morphine if they must. Bob’s been stealing and shooting drugs all his life. Been busted. Sent to prison. Now he’s 26. Married to Dianne (Kelly Lynch). They’re training a new guy and his girlfriend, Nadine (Heather Graham). Nadine has a special talent: she can simulate seizures really well, a noteworthy distraction to lure an unsuspecting pharmacist from behind the counter long enough for Bob to rifle through the drug drawers in back and get away.

We are taken along on drug heists, shooting up scenes, nasty encounters with police, a troubled visit to Bob’s estranged mother’s house, and a road trip. All these scenes are roughened: nothing happens neatly. There’s little glamour. Even the depiction of a few of Bob’s opiate-induced reveries convey that these are only brief narcotized moments in a life dominated by hustling and danger. The others may be capable of some pleasure, but fun eludes Bob. The best he can hope for is brief drug-induced respite from bad feelings.

One night Nadine shoots up a lethal overdose while the others are out stealing. Bob promises God that he’ll clean up if only the gang can get through this scrape unapprehended. They do, and after burying Nadine’s body in the woods, Bob announces he is returning to the city to enter a 21-day methadone detox program. No one else joins him. The scene shifts to Bob’s early recovery. We see him in therapy groups and starting an apprenticeship as a machinist’s assistant. He lives in a SRO in the skid road area of the city.

Authenticity here can be credited to the novel on which the film is based, by James Fogle, a lifelong drug addict and criminal who wrote the material while incarcerated at a Washington state prison. The film accurately portrays the hustling life of a typical junkie as joyless, a continual effort to stay a step ahead of withdrawal and the police. And major depression is also rampant among opiate addicts, occurring eventually in over 50%.

It takes a clever mind to succeed in hustling; many addicts are resourceful, like Bob. That’s one reason peer-run therapeutic communities succeed, and that recovering addicts can become skillful counselors. No false signs or symptoms of drug use are presented here. The only soft spot in this otherwise realistic film is the ease and rapidity of Bob’s early recovery. His steady, incremental success would be more likely to occur had he been placed on methadone maintenance rather than detox.

Comparing these two films, what impresses me most is the turn-on-a-dime decision to pursue recovery in both cases. Alcoholism authority Marc Schuckit has noted that the turning point toward an addict’s recovery is often an epiphany like Jia’s or Bob’s, a profound change of spirit and mindset that can come suddenly and without precedent or easy explanation. How can we understand this phenomenon? Or hasten it? I wish I knew.

The annual OHSU Rondeau Lecture a month ago featured the screening of a stunning new documentary film, Out of the Shadow, with its director in attendance. It is the story of Millie, a woman suffering from chronic schizophrenia, and it was made by a veteran documentarist, Susan Smiley, who happens to be Millie’s daughter. This film is quite short – 67 minutes. I mention this to emphasize how carefully constructed the film is. All the important issues concerning the experience and consequences of schizophrenia are illuminated here with compelling clarity, authenticity and thoughtfulness, with no hint of superficiality or breeziness, free of sentimentality of any sort, yet with clear conveyance of the filmmaker’s deep respect and obvious love for her mother and family.

Millie was 25 when she first showed signs of schizophrenia, or perhaps its prodrome, shortly after Susan’s birth. Her erratic behavior and irritable mood swings became so intense that Susan’s father divorced Millie, leaving her to care for Susan and baby sister Tina, ages 3 and 1 year. Millie often beat Susan, who was more defiant, while Tina shielded herself through ingratiation. But Susan left when she was 12 to live with her father and stepmother. Tina thereafter bore the brunt of Millie’s rages. How could the father and others let this situation go on? For one thing, Millie often had periods of ostensible normality, when she seemed quite loving. For another, the girls wouldn’t tell anyone how bad things could get at home, fearful that their mother might actually kill them. It was all too easy for the other adults to deny the extent of the problem, and this they did for years, a situation that changed, apparently, only after Tina made a suicide attempt, in early adolescence.

What ensued was a wretched 20-year odyssey for Millie and her daughters that is all too familiar to anyone close to a person suffering from severe chronic schizophrenia: 17 hospitalizations, 40 or more living places, no employment, frequent brief periods of homelessness, a serious suicide attempt. A procession of ever changing mental health providers and caseworkers, constantly revised medication regimens, as Millie received care within a system Ms. Smiley accurately describes as “fractured.” Ms. Smiley’s restraint – her canny ability to avoid axe grinding harangues, instead simply showing us over and over again how the system fails to work – is remarkable, and a source of the film’s power. (Though Millie lives in Illinois, the “system” there functions about like that in any other state.)

Meanwhile, the girls grew up: Susan moved to Los Angeles to make films, and Tina married and moved to Minnesota. Time and again their efforts to keep track of their mother were frustrated, not only by Millie’s erratic comings and goings, but also by regulations that prohibited caregivers from giving information to them about her whereabouts or condition without Millie’s written consent, something Millie routinely denied, even though she was usually pleased when her daughters finally found her again.

Another major issue, unsurprisingly, has Millie’s abiding lack of insight. She always maintained that she had no mental disorder, though she feared she might acquire one from being placed in care situations with mentally ill people. Thus she saw no reason to take psychiatric medications, and she also was troubled from their side effects (at one point we see that she takes 7 different psychiatric drugs), another justification to avoid taking them.

One of the more poignant exchanges in the film occurs between Susan and Tina, a disagreement about Tina’s use of deception to get Millie to consent to taking a depot antipsychotic drug. Tina, certain that Millie would refuse to sign for medicine by injection, tells Millie the consent is to arrange better housing. Susan is displeased. But Tina’s defense of her action is not without merit. She argues that the regulations in effect prevent needed care, and emphasizes the consequences if their mother goes unmedicated. In other words, for Tina, the end justifies the means.

Ms. Smiley and her editors have crafted their film with a skillful mix of family photos, old home movie footage, and contemporaneous digital video scenes and interviews, which center on Millie, though there are many scenes in which Susan, Tina, their father, other relatives, and caregivers participate. The filmmakers also effectively blend direct dialogue audio, accompanying the digvid footage, with voiceover narration by Susan. The story moves between past and present in a confident, unhurried manner. We don’t just see Millie as a patient, a collection of symptoms and social conundrums. Ms. Smiley is careful to show us the brighter, more charming side of her mother, who was strikingly attractive in her 20s and is still capable on her good days of conveying the soft, endearing side of her personality. What we do see is how emotionally changeable, how mercurial, she can be.

Occasional interludes, like a nocturnal drive along a commercial street, serve to give viewers relief from the tough story here while giving Ms. Smiley time for some narrative comment. Spare music (piano, guitar) is used just occasionally, and not with any intent to manipulate viewer response; rather, the music, like one or two of the visual interludes, seems almost to be provided more for our respite.

There is a happy ending, and it is not at all contrived. In fact it was a product of long hard work by Susan and Tina, and also some simple good luck. A guardianship was finally arranged for Millie, who’s also taking one of the newer antipsychotic drugs. She seems pleased with the guardianship: “I’ll be attached, have roots, have stability,” she says. “I’ll no longer be an orphan.” Her daughters can now apply for Millie’s placement in a group home, what Susan calls the “holy grail” of care in the Illinois system. It will be a small place with skilled supervision and good care, and a guarantee against eviction. First Millie must pass a strenuous group interview in which her mental state remains very well controlled. To everyone’s pleasure, not to mention surprise, Millie passes. She still must wait in a nursing home for a year before a group home vacancy occurs. But it happens. Later, she joins her ex-husband’s second family and her daughters for a Christmas gathering that everyone enjoys. And, near the end, she even begins her first job in 30 years, as a dishwasher in a nearby restaurant. She may still lack insight, but she’s stable and proud of herself.

I have only two small criticisms of the film. Ms. Smiley says she is reassured because, having reached her late 30s without signs of schizophrenia, she is confident that she will not develop the illness. I wish I could concur. In fact she and her sister will continue to be at higher risk than the general population for developing this disorder at least through their mid-40s. In the end credits, Dr. Xavier Amador is cited as the film’s “psychiatric consultant,” but he is not a psychiatrist. I have no wish to criticize Dr. Amador, who is a respected clinical psychologist with expertise about schizophrenia. But I do think that “psychiatric” consultant is not the correct title for him. (I note that several prominent psychiatrists did receive credits for assisting Ms.Smiley on the film, including Drs. Michael First, Edward Foulks, E. Fuller Torrey, and Peter Weiden.)

This film is truly a tour de force: a drama with a meaningful narrative arc, central characters who are all sympathetic, and a comprehensive, thoroughly edifying look at the problems of chronic mental illness in this country. And all in just over an hour. How one wishes that more filmmakers could be so economical! More importantly, Ms. Smiley has somehow managed simultaneously to grace her film with a sense of deep emotional involvement and also a scrupulously dispassionate gaze at the problems for everyone posed by her mother’s illness and the faulty public care system on which they all must depend. In her final voiceover, Ms. Smiley notes that although her mother still sees herself as the victim of a system, not an illness, of course she’s a victim of both. This film should be required viewing for anyone working with or interested in people suffering from schizophrenia or other severe and persistent mental disorders.

A cartoon in a recent issue of The New Yorker magazine shows a man chatting with the minister after a Sunday church service. “Oh, I know He works in mysterious ways,” the man says, “but if I worked that mysteriously I’d get fired.” The tone was more severe in Angels in America: A Gay Fantasia on National Themes, Tony Kushner’s epic play, adapted by Mr. Kushner and directed by Mike Nichols for the small screen on HBO last year, and now available on 2 DVDs. When Prior Walter (Justin Kirk), a gay man dying of AIDS in the mid 1980s, is given an opportunity to address a panel of Angels at the gates of Heaven, he discovers that a reactionary God became bored with man’s restless quest for progress and change, and vanished in disgust early in the last century, on the day of the 1906 San Francisco earthquake, to be precise. Outraged by what he perceives as an act of such gross irresponsibility, Prior rails at the Angels, “If God shows up again, sue the Bastard for walking out!”

Offered the choice between staying on in a comfortable if Godless Heaven and returning to a life dominated by suffering and uncertainty, Prior doesn’t hesitate: he chooses life over death because, as he says in a longish speech, where there’s life there’s hope. That’s really what this six hour miniseries comes down to: yes, the world’s a terrible, treacherous place; yes, there is little evidence of peace or justice, or of the love that they engender; yes, our efforts to move forward may merely amount to what Prior terms “a kind of painful progress.” But it is life here on earth that counts and to this we must commit ourselves.

No institution in our society goes unskewered here. Our world is branded as “terminal, crazy and mean.” After a meandering cavalcade through the deeply troubled human arenas of faith, religion, politics, love, hatred, sexuality, marriage, prejudice, poverty, privilege and illness in the midst of the Reagan years, we emerge confronting a spirituality that is both minimalist and earth-bound, not elaborate or Heaven-inspired.

When the Angel of America (Emma Thompson, who received no awards for her turn here, although I think she deserved something just for being a good enough sport to take on such a ridiculous role) visits Prior, she embraces him in literally electrifying sexual union, making use of all 8 of her vaginas. Magical realism may lace this production lavishly, but make no mistake, we're talking a seriously corporeal spirituality here, nothing ethereal about it.

You probably know the history by now. In 1987, a group in San Francisco, the Eureka Theater, commissioned Kushner’s play about AIDS in the gay community. Part 1 (Millenium Approaches) debuted in Los Angeles and San Francisco in 1991, then in London, before a Broadway debut in 1992 that won a Tony Award for Best Play and a Pulitzer Prize for Kushner. Part 2 (Perestroika) followed on Broadway in 1993. Critic Harold Bloom listed this play as one of the most important literary works of the 20 th century.

The timing of the stage productions was fortuitous – around the fall of the USSR and Berlin Wall, and before the upturn in the U.S. economy and better drug strategies for AID S. The timing of the HBO production is even more poignant, with AIDS now spreading across the developing world, and the excesses and hypocrisies of our present government making the Reagan era seem in some respects like the good old days. Not to mention the apocalyptic miasma that has enshrouded us since 9/11: near the end of the final hour, we see a silhouette of the lower Manhattan skyline (it’s 1990), and there are the twin towers of the World Trade Center, rising ghostlike in fuzzy gray tones.

This miniseries, shot in New York City (except for the Heavenly scenes shot in Tivoli, Italy), teams with characters, subtexts and scenes, but it’s all pretty easy to follow. Prior’s gay partner of 4½ years, Louis (Ben Shenkman), a neurotic headtripper of Woody-like proportion, cannot face Prior’s illness and abandons him. Meanwhile, Joe Pitt (Patrick Wilson), a devout Mormon Republican lawyer, is involved in a disintegrating marriage to dependent, Valium-addicted Harper (Mary-Louise Parker). Joe is struggling to suppress his own longstanding homosexual yearnings. Joe is also a protégé of the notorious attorney Roy Cohn (Al Pacino), yes, the same malevolent shark who served as Joe McCarthy’s chief counsel and as a prosecutor at the Rosenberg espionage trial in the 1950s.

Cohn is a nasty man who is proud of his base and unethical machinations. He hates Communists, liberals, racial minorities and gays, though he is a barely closeted homosexual himself and, as it turns out, is also dying of AIDS in 1985 (Cohn did indeed die of AIDS in 1986, claiming to the end that he had liver cancer, just as portrayed here). Joe abandons Harper, and has a brief affair with Louis, whom he has met at work.

Feverish Prior has visitations from ancestral ghosts (he’s from a family that has been prominent forever) and Angels. Wildly improbable as they may be, these visions ably serve several dramatic purposes. They provide grand spectacle, something that delights post-modern theater audiences, and that in fact is put in even finer form on the screen, thanks to CG technology and splendid production design by the veteran Stuart Wurtzel. These dazzling visitations also are as energizing for viewers as they are for Prior: they keep one awake and aroused amidst the pathos of life in these United States. Whether they also properly imbue the proceedings with the sense of millennial high stakes that Kushner wants is more open to argument.

There is a great deal of unevenness in this series. Some characters are better than others. Pacino and Kirk are fine. Mr. Shenkman is rather one-dimensional, too much the immature urban Jewish stereotype, and the fiercely Angelic Ms. Thompson (who also plays an AIDS nurse and a homeless person of indeterminate gender in a vacant lot in the Bronx) is, well, awfully feathery. The institution of marriage takes quite a beating in the film, and I cannot be sure if this is Mr. Kushner’s intention, or if it is a product primarily of the acting limitations of the zoned out Ms. Parker and, especially, the wooden Mr. Wilson.

The dialogue is highly variable, almost as if written by a committee. There is a fair measure of humor to be found, though not a lot. Amidst the argot of 1980s New York City, there are scenes that have the ring of Shakespeare, others of Thornton Wilder, still others of a more canny 18 th century wit, like the early Cocteau-inspired fantasy scene in which Harper and Prior discuss the limits of imagination. The introductory musical theme, featuring oboe, sounds very much like the music from the HBO Series, Six Feet Under. Small surprise, then, to find it was written by the same fellow, the prolific Thomas Newman.

I haven’t yet mentioned the two best characters in the series: Meryl Streep (who plays a Rabbi; an Angel; the ghost of Ethel Rosenberg, who visits Roy Cohn's deathbed; and Joe Pitt’s matter-of-fact, unflappable mother, Hannah – her lead role), and Jeffrey Wright, who reprises his Tony Award-winning stage roles in AIA: Perestroika (he plays the former drag queen Belize; an AIDS nurse; and lesser roles as Harper Pitt’s fantasy tour guide, Mr. Lies, and, briefly, an Angel).

Hannah Pitt drops her widow's life in Salt Lake City and rushes to Brooklyn in an attempt to rescue Joe and his marriage, both beyond repair as it turns out. But she finds plenty to do taking care of Prior and others, and adds a bit of drollery as well. Belize, full of wisdom, wit and swish for every occasion, is even helpful to Roy Cohn, who offers only insults in return. Prior Walter may be a valiant fighter struggling against all odds to cling to life, but it is Hannah and Belize who are the tough, unsentimental, resourceful sorts that respond best to those around them in need. If humanity does move forward, as Prior hopes, these are the stalwarts we will need.

“The Woodsman” may be the best fictional film ever made about pedophilia. Kevin Bacon plays Walter, a man just released from prison after serving a 12 year term for molesting young girls. Walter returns to Philadelphia, where he grew up, and tries to restart his life. He gets some breaks: he’s offered a job at a lumberyard where his father had worked. Though his relatives have all severed ties, a brother-in-law, Carlos (Benjamin Bratt), still befriends him. And Vickie (Kyra Sedgwick, Mr. Bacon’s wife), a hard-edged coworker, takes a liking to him. Walter is guarded, taciturn, tries to steer clear of anything that smells like trouble. He’s intelligent enough, but a simple fellow. Doesn’t read or listen to music or seem to ever go anywhere. He enjoys a beer and a ball game on TV with Carlos now and then. He sees a psychotherapist weekly.

He rents a small apartment across the street from a grade school. This is doubly odd. Why would Walter choose a place where temptation is so close at hand? And why would he be permitted by his parole officer to situate himself so close to kids of an age that had attracted him earlier (girls 9 to 12)? Indeed, about the only false note in this film is that we never see any sign that Walter is being supervised by a P.O. This doesn’t mean that the law is unobservant of him.

Indeed, early on, Sgt. Lucas (Mos Def), a deceptively gentle police detective who can turn insulting and vicious in a millisecond, pays a call. A young girl has been attacked in the neighborhood. Lucas wants Walter to understand that he is constantly being watched, is automatically considered a potential suspect in any such crime, and that Lucas himself is absolutely certain that it is only a matter of time before Walter will molest another child, get busted, and go back to prison for life.

Walter spends a lot of his spare time just gazing out at the street and school grounds. He begins to notice a man hanging around, watching and trying to engage in conversation with young boys. He sometimes carries a bag of candy to offer the kids. Walter nicknames him “Candy,” and begins methodically to keep notes on Candy’s conduct. Meanwhile, Walter and Vickie become sexually involved. She pushes for him to share his secrets, which he finally does. She is naturally shocked, and Walter interprets her response as evidence that his problems are a deal breaker, so he defensively yells at her to leave.

At work Walter spurns some initial flirtation directed his way by the office secretary, Mary-Kay (Eve Jeffers). She is not pleased with this, especially when she later sees Walter enjoying lunch chats with Vickie. Mary-Kay discovers the story of his conviction at a Website displaying criminal profiles, and she spreads the word around the yard that he’s a pedophile. Matters turn progressively ugly, to the point that Walter must leave the job. He attends his counseling appointments regularly, but the therapist is stupendously inept, unable to convey any real empathy or interest in Walter. He wants to try to reconcile with his sister, but she refuses to see him and even has Carlos return a handsome cherrywood table that Walter had made years ago as a wedding present.

It is in this context of multiple mounting stressors - troubles at work, isolation, more menacing visits from Sgt. Lucas, closeness and then failure with Vickie, worry that Candy will kidnap some little boy, and no one to turn to for help - that Walter begins once again to experience obsessive desires for little girls. He thinks about them. He watches them commuting on the bus. Such is his increasingly tenuous self control that he even manages to alienate the one person from his past who has remained loyal, Carlos, by asking if his brother-in-law ever has sexual feelings toward his nine year old daughter.

Walter begins to stalk a young girl who always rides his bus. One day he follows her into a park, striking up conversation as she watches birds through binoculars. After quitting his job, and without Vickie to occupy him, he returns to the park. The same young girl appears and they talk together on a bench. It is striking to see how Walter warms to her, opens himself, smiles with genuine, relaxed pleasure in her presence, something he cannot do with any adult. He invites her to sit on his lap. Her face clouds over and a tear or two appear, and she tells Walter that her father likes for her to sit on his lap at home.

Walter asks whether that is pleasant for her, whether her father rubs his legs against her in an unusual manner. Her stricken glance and tears affirm for Walter that no doubt her father has used her as Walter himself used young girls in the past. She tells Walter she will sit on his lap if he really wants her to, but the revelation that her father's conduct has been emotionally hurtful to the girl registers with Walter. Perhaps for the first time, his self-serving belief that he had never hurt the girls in the past is shattered. He gently declines her offer and suggests that she should probably go on home.

Later that day he sees Candy let a young boy out of his car, one that Candy had been cottoning up to near the school grounds days earlier. Walter attacks Candy from behind and beats him thoroughly. Next day Sgt. Lucas pays another visit. Almost offhandedly he mentions the attack on a man in the neighborhood. The man survived but with a skull fracture and claims he could not possibly identify his assailant. It turns out Candy was wanted for attacking a young boy in another state. Walter visits Vickie and they renew their relationship. Some weeks later Carlos arranges a brief visit for Walter with his sister. It doesn’t go well, but Vickie reassures him that these things take time. The film ends on this ambiguous yet also hopeful note.

This was a directing debut for Nicole Kassell, who collaborated with Steven Fechter to adapt his script for the stage. The film is very well crafted, neither lurid nor judgmental in tone, and the informal dialogue and flow seem highly cinematic, often a very difficult thing to achieve in adapted stage dramas. As noted by many reviewers, it was brave for both Ms. Kassell and Mr. Bacon to take on a project addressing a theme that is so repugnant to most people.

Bacon gives an extraordinary performance here, somehow conveying the many nuances of the problem of his character’s pedophilia. We can see that Walter’s compulsion to repeat acts that could be so ruinous to the young girls and to himself at times outstrips all reason and prudent judgment. We see too that these obsessions increase as the circumstances of Walter’s post-prison life unravel and stresses mount. The interest in the girls is thus partially a defense against anxiety.

But it’s not that simple. Walter appears to be fully capable of sustaining a sexual relationship with an adult woman: it’s not that he can only be aroused by youngsters. And yet he seems somehow more fulfilled, more relaxed, more emotionally open, safer, even delighted, in the company of a nine year old than with Vickie or any other adult. Is it a sign of immaturity that he feels more confident relating to kids than to grownups? The complexity and mystery of his pedophilia is portrayed but never explained, and this is as it should be.

There are no pat answers to such problems, no one-size-fits-all formula, only the fact that such patterns and impulses are not easy to overcome on a permanent basis, no matter what the stakes. Certainly the love of a caring partner can help. Having a competent psychotherapist would also help. Then there is the parole officer, absent entirely here, a figure who at best can be an influential supporter in the efforts of people like Walter to make good.

My partner and I sometimes actually travel to see films in other places. May found us in Vancouver, BC, for the 2nd annual “Frames of Mind” Mental Health Film Festival, sponsored by the Department of Psychiatry at UBC. One highlight was a screening of The Sterilization of Leilani Muir. In 1995, Mrs. Leilani (Muir) O’Malley, then age 50, became the first person in Canada to successfully sue a province (Alberta) for damages as a result of having been sterilized at age 14, without her knowledge or consent, under an Albertan law (on the books from 1928 to 1972) that permitted such procedures for persons assessed to be mentally retarded.

At age 11 she had been left at the doorstep of a state “training school” by her mother, who simply wished to be rid of her. She received no formal mental assessment whatsoever for two years, then a single “I Q test” on which she scored around 70. This was the basis for the surgical procedure. (Over subsequent years other tests have shown that she has normal intelligence.) She was told only that she had had an appendectomy and did not discover the fact of her sterilization until a gynecological examination sought many years later after failed efforts to become pregnant.

This short documentary very effectively recounts Ms. Muir’s personal story set against a larger subtext of the eugenics movement that began in North America in the 1880s and reached its peak in the 1930s. Eugenics was a pseudo-science that embraced the idea that the human race would be improved if its mentally handicapped members were not allowed to procreate (after 125 years, there's not a shred of evidence to support this conjecture). The idea caught on first in the U.S. In 1907, Indiana became the first state to enact a compulsory sterilization law for institutionalized developmentally disabled individuals, dispensing with patient consent.

By 1929, the year after Alberta’s law was enacted (the first of just two Canadian provinces to do so, the other being British Columbia), 30 states had such laws on the books; in 1936, 32 to 35 states had enforced sterilization laws for retarded citizens. Once widespread knowledge emerged about Nazi atrocities based on eugenics, this movement was rapidly discredited. Most states gradually abandoned the practice of forced sterilizations after the 1950s and many later repealed the laws that enabled the procedures. But in some states, like North Carolina, these laws are still on the books. To my knowledge only one state, Arkansas (in 1969) enacted a compulsory sterilization law after 1942.

All told, more than 60,000 sterilizations were carried out in the US under these laws, about a third in California alone (it is documented that the Nazi regime regarded the California experience as proof that a eugenics program could be successfully carried out on a large scale). There were over 2,800 procedures in Alberta and roughly 200 in British Columbia. After Ms. Muir’s successful compensation suit (she received an award of $CA 750,000), $55 million was later set aside to settle 200 further claims by surviving victims of sterilization in Alberta. A suit on behalf of 9 surviving victims in British Columbia is working its way through the courts now.

Thus far in the U.S., there have been public apologies to victims of forced sterilization by officials in at least two states (Virginia, Oregon) but no compensation. A long ago lawsuit declaring the Virginia statute unconstitutional reached the U.S. Supreme Court in 1927, prompting Judge Oliver Wendell Holmes, writing for the majority, to issue his infamous eugenics infused opinion that, "It is better for all the world, if instead of waiting to execute degenerate offspring for crime, or to let them starve for their imbecility, society can prevent those who are manifestly unfit from continuing their kind. The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes. Three generations of imbeciles are enough." Since then, as far as I can discern, there has been no case brought in federal courts to challenge the constitutionality of sterilization laws.

This film is well crafted and provocative, an excellent trigger for discussion and debate of an issue that is far from settled. The very fact that Ms. Muir herself was clearly not developmentally disabled raises the grim question of how many among the 60+ thousand U.S. sterilization victims were misdiagnosed.

At the “Frames of Mind” screening, Mrs. (Muir) O’Malley, herself, and Jay Chalke, Public Guardian and Trustee for British Columbia, took part in a Q & A. Ms. Muir, who is poised, articulate and passionate about the issues, has shown this film and spoken to numerous groups in Canada and the U.S. over the past few years and hopes for new opportunities to take her film and story further afield, both in the U.S. and to developing nations.

Mr. Chalke informed us that just this session, the North Carolina legislature is considering a bill to designate a sizable fund for settlements with surviving sterilization victims in that state. When asked why it was that only the two westernmost provinces in Canada enacted forced sterilization laws, Mr. Chalke indicated that the greater influence of the Roman Catholic Church in the eastern provinces was no doubt a significant factor, as the church had always opposed sterilization under nearly all circumstances. It has also been noted that the states in the U.S. having sterilization laws tended to be those with Protestant majorities. Blacks received a disproportionate share of forced sterilizations in some southern states. At one point such procedures egregiously perpetrated on blacks were even referred to as “Mississippi appendectomies.”

A related issue was raised in the discussion by the mother of a 34 year old severely retarded woman. The mother has sought unsuccessfully for years to arrange a sterilization for her daughter, who lives at home. The mother argues persuasively that it would be tragic for her daughter to become pregnant, because of health problems, the trauma of pregnancy and birth, and her unfitness for motherhood. But physicians, hospitals and courts are reluctant in such cases to turn away from the common law rule requiring patient informed consent to surgery, and in this particular case, planned surgery has been cancelled at the last minute on three occasions. This is a dilemma without a clear-cut solution.

In June, while in the D.C. area, we attended Silverdocs. No, it’s not a gathering of over-the-hill physicians. It’s a large documentary film festival based at the old Silver Theater in Silver Spring, Maryland, remodeled not long ago by the American Film Institute. AFI partners with the Discovery Channel to put on this festival, now in its third year. There’s something for everyone among the 90-odd films, including more than a few with psychiatric and psychosocial themes. One of the better such offerings was The Self-Made Man, the story of Bob Stern.

A tough maverick businessman, Mr. Stern made enough money in steel and real estate to retire at 37 and move to an isolated but sunny acreage not far from San Diego, where he installed a photovoltaic electrical system and proceeded to live off the grid with his family for the next 40 years, trying without success to promote alternative solar energy. A man born before his time. Antiauthoritarian, strong willed to a fault, a control freak, he reckoned all of life’s decisions on a careful cost benefit analysis. And then he got sick.

His daughter Susan has made a film of her father’s struggle over what to do about his health problems, using as the central footage a videotape he made in the final days of his life, in which he sets forth his analysis of whether to submit to surgery or kill himself. She weaves other material around this footage: reflections of her father’s friends and family members about the sort of person he was, and biographical information about him.

Of his choice of shooting himself to end his life, which he did at age 77, his son Mike puts it best when he says that his father must have decided, as in his business dealings, that he "was no longer a good investment and it was time to sell." There is a certain arbitrariness, even callousness, about Stern’s conduct at the end. The tape he made betrays a considerable degree of insensitivity in this man toward the feelings of his devoted wife and children. (There is also ample evidence that he was insensitive to many people throughout his life.)

His health problems, while formidable, were not necessarily life threatening: he had a recently discovered abdominal aortic aneurysm that needed surgical repair, and also had slowly developing prostatic cancer, apparently noninvasive and nonmetastatic. Otherwise, he seemed fit. He would not come close to qualifying for physician-assisted suicide under the Oregon law. Judging by the tape, he was not depressed, demented or psychotic when he made his choice to die.

This film is troubling first of all because in the tape he made, Bob Stern confronts not only his family but every viewer with his struggle and its discomforting resolution. He looks at each of us squarely in the eye. He and his family (all of whom opposed his suicide) raise tough questions about the proper limits of autonomy, the collision of interests of the individual and his or her family, and what to do about such conflicts. Stern appears to be so coolly rational about it all. Susan Stern wondered aloud at the Q & A following the screening whether, perhaps, her father was in the end “not strong enough to face being weak.”

Most of us don’t regard ourselves as self-made, in Stern’s mold. We understand the interdependencies with other people and circumstances that have shaped the course of our lives. We are social beings. No man is an island, John Donne said. Being so constructed, the question arises whether the assumption of being rightfully entitled to exercise complete individual autonomy is in fact validly grounded. Speaking of her father, Susan Stern says there is a fine line between isolation and independence. Her film leads me to wonder whether there is also a fine line between autonomy and selfishness. (This film is scheduled to be shown on the PBS program, P.O.V., on July 26.)
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The Sterilization of Leilani Muir was directed by Glynis Whiting (Canada, 1996, 47 min.). The Self-Made Man was directed by Susan Stern (U.S., 2004, 58 min.). For other reviews, visit my websites at Psychflix.com and AtkinsonOnFilm.com.

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"REEL LIFE":
THE CLINICAL PSYCHIATRY NEWS REVIEWS

HOW DO YOU FILM A DELUSION? - II(modified version of "Reel Life" column in Clinical Psychiatry News, December, 2003)

Canadian director David Cronenberg’s recent film, Spider, tells the story of a man suffering from chronic schizophrenia whose present dysfunction is linked to circumstances when he was a pre-teen. Dennis Cleg (Ralph Fiennes) was sent to a public mental hospital after a tragic event when quite young, but now, as the film opens, after years of confinement, he is being outplaced to a residential board and care facility in East London, in the neighborhood where he was raised. Back in old familiar haunts, Dennis finds himself increasingly preoccupied by painful, unbidden recollections of his childhood, which ended very badly indeed. Here’s a warning: in discussing this film I will reveal information that can spoil surprise turns in the story.

Dennis’s reveries, alternating with scenes of his present life throughout the film, are presented in a series of vivid, lengthy flashbacks in which the adult Dennis is a ghostly witness standing unseen next to his parents and himself as a 12 year old. His mother (Miranda Richardson) had nicknamed him “Spider.” Young Spider is withdrawn and friendless, bound closely to his mom at an age when boys normally prefer to go off with their buddies. Mom also finds comfort in being with Spider; it makes up a bit for her loneliness. Then, possibly in desperation, she starts to doll herself up and drink more in an effort to rekindle romance with her husband, Bill (Gabriel Byrne), who has shown signs of straying from the matrimonial bed. Her tete-a-tetes with Spider dwindle. Perhaps Spider is just imagining that Mom has changed, his perceptions distorted through the prism of his own sexual awakenings. One day he is taken aback to find her preening in front of a mirror in a blue slip. He begins to misperceive his mother as a tart like one who frequents Dad’s favorite pub. No doubt already psychotic, he forms the delusion that Dad has killed his brunette Mother and taken up with this bottle-blonde floozy, “Yvonne” (also played by Ms. Richardson). Spider accuses them both of being murderers, and ultimately seeks revenge by turning on the unlit gas stove one night while Yvonne slumbers drunkenly nearby. She dies as a result, but when Dad drags her body outdoors, her appearance is transformed into that of Spider’s Mom.

The story does not unfold as straightforwardly as my synopsis suggests (just as a case summary is better organized than a patient’s more haphazard account). Cronenberg and screenwriter Patrick McGrath, who adapted his own novel, use the same strategy as the makers of the most popular recent film about a person with schizophenia, ABeautifulMind, insofar as they draw us into the action as it is perceived by the psychotic person. We see Dad strike Mother a death blow with a shovel when she discovers him in sexual throes with Yvonne.Thus I thought at first that Dad had killed Mother and taken up with another woman, despite the clue provided by having Ms. Richardson play both roles. Only later - in a scene by the garden shed when Dad seems so gentle, so kindly, as he expresses to Spider his puzzlement over his son’s accusations - did I begin to realize the truth: when we see Dad kill Mother and bury her body with Yvonne’s help, these events can only have been a delusion in young Spider’s mind.

Depicting schizophrenia poses major problems for a filmmaker, because its defining features are disorders of thinking and perception – symptoms that a camera can’t see. This problem can trip up anyone who wishes to portray schizophrenia honestly. Many directors wisely decide to rely exclusively on the schizophrenic character’s manifest behavior and quirks of speech that may suggest a disorder of thinking processes, and make no attempt to represent their inner experiences more directly. Think of Geoffrey Rush’s manic but disorganized conduct in Shine, Janet Margolin’s clanging speech in David and Lisa, Sean Gullette’s tightly wound paranoid frenzies in Pi, or Robert Duvall’s brilliant wordless cameo as the shy Boo Radley in To Kill a Mockingbird. Other filmmakers employ surreal artistry or magical realism to suggest bizarre inner experience: for example, Salvador Dali’s scenes of the protagonist’s fugue experiences in Alfred Hitchcock’s Spellbound, or Angels of the Universe, a recent Icelandic film about a schizophrenic man who, while acutely psychotic, walks on water like Christ. Ron Howard also uses visual gimmickry to represent some of mathematician John Nash’s delusional insights in Beautiful Mind.

Trouble is, surrealism misses the mark. The problem lies in the nature of the symptoms. Delusions may be highly complex yet unaccompanied by visual or other sensate perceptions (except, in some cases, for geometric or other arcane symbols). Hallucinated voices are typically disembodied from visual human forms and emanate from the spatial hemisphere behind the patient. Visual phenomena tend to be shadowy, ill formed, darkly diaphanous. Other hallucinations can be tactile (especially sexual) or olfactory (foul odors are common). One can easily understand a filmmaker’s desire to use the medium to go beyond the surface conduct of the psychotic protagonist. But given the nature of the inner experiences, how can one portray them authentically and at the same time maintain narrative and visual coherence? The other alternative, depicting only behavioral correlates of inner experience, leaves the viewer, like the psychiatrist, still on the outside looking in.

As far as actions go, no one could ask for more than Fiennes delivers here. It helps that he has a thin body build, like many schizophenic persons (unless bloated by inactivity and medication-induced weight gain). Fiennes gets posture and movement right: the awkward stiffness and impoverishment of activity seen so commonly in schizophrenia, features also compounded at times by antipsychotic drug side effects. He is the first actor I’ve seen who mumbles, like many symptomatic schizophrenics, subvocalizing thoughts and voices. Perhaps most important of all, Fiennes conveys a sense of deep apprehension, a wild fearfulness like a deer at night caught in a headlight beam. As his character’s recollections of the events culminating in his mother’s death weigh in upon him more and more, Fiennes is able to ratchet up the level of his anguish, the fervor of his compulsive efforts to ward off bad feelings and thoughts by scribbling nonsense hieroglyphics in his notebook, and, toward the end, the increasing paranoid concern that Mother will seek revenge on him, as he begins to misperceive the woman who runs the board and care home (Lynne Redgrave) as his mother (also briefly played at this point by Ms. Richardson).

Not content with Fiennes’s exceptionally gifted performance, Cronenberg wants to go further, employing several strategies to portray Dennis’s internal experience. First, in the aforementioned sequence when Dad “kills” Mom, he substitutes complex realistic scenes for young Spider’s delusional thoughts and thus, in the process, he puts the audience in the schizophrenic protagonist’s shoes, like Howard did in Beautiful Mind. Now we are on the inside looking out. But the cost of aligning our (false) view of reality with that of the schizophrenic character is the misrepresentation of schizophrenic symptoms. Imaginary complex life-like scenes do occur normally in some highly creative, visually-oriented people, and in so-called “lucid dreams,” partial complex seizures, delirium and hysterical hallucinations. But they are very unusual in schizophrenia. To his credit, Cronenberg limits use of this conceit to one instance (Dad killing Mom) and he always keeps the adult Dennis on the sidelines as a nonparticipating witness to this and all his other reveries. In contrast, Howard had Russell Crowe (playing Nash) repeatedly cosy up to imaginary friends and co-conspirators in scenes that are more grossly inauthentic.

Nor does Cronenberg light up his movie like a Disney sitcom, the way Howard did much of the time in Beautiful Mind. Instead he uses dark, shadowy, bilious green lighting and spare, at times liturgic music to convey to viewers the morbid sense of foreboding experienced by the adult Dennis. The transitions between scenes of Dennis’s current life and childhood reflections are seamless. Indeed, the fluidity of the boundary between past and present increases as the movie progresses. In this manner Cronenberg subtly but surely shows us the gradual breakdown Dennis is experiencing - his increasing confusion of humdrum current reality with tormenting recollection and reverie.

Some lay viewers have complained that Fiennes’s Dennis is inaccessible, too lacking in ordinary emotional expression to comprehend. This can make the film seem to drag. In a similar manner, some reviewers of BeautifulMind said that Russell Crowe did not clearly articulate inner emotions. Such critics betray their lack of clinical knowledge. They want their schizophrenic characters to behave like good neurotics. Persons with schizophrenia often have great difficulty accurately expressing emotions in ways others can fully understand and empathize with. So the screen portrayal of schizophrenia poses yet another dramatic dilemma: the more authentic the acting, the tougher it may be to attract and emotionally sustain viewer interest.

People have also complained that the portrayal of schizophrenia in Spider is gratuitously stigmatizing, that it does not reflect the more “normal” conduct of many patients with this disorder. It is certainly true that some patients have little or no symptomatic residue between psychotic episodes. And, as we know, proper treatment can in many cases mitigate hallucinations, delusions, and bizzare behavior in people with chronic schizophrenia. In particular, the film might nourish popular fears about mentally ill patients being violent and dangerous. We like to downplay the violence issue because crimes against persons committed by people with mental illness so often are sensationalized in the media and overly generalized in the public mind. When properly treated, persistently mentally ill people are not more dangerous than the general population.

The plain fact is, however, that many persons suffering from chronic schizophrenia and allied psychotic disorders are not taking medication. They either refuse treatment, cannot afford it, or live in places where good care is not available. A recent survey of the professional literature conducted by The Treatment Advocacy Center, an independent nonprofit organization dedicated to removing barriers to the treatment of severe mental illness, makes it abundantly clear that untreated severely mentally ill individuals are decidedly more dangerous than the general population. Because many people with mental illness live with or close to family, it is not at all surprising that relatives are the most frequent victims of the violent acts their psychotic kin commit. That said, the instance of completed matricide by a psychotic youth is rare indeed. I could find just a single case report along the lines of this story in a literature search covering the past 30 years.

It may not trouble anyone but a few psychiatrists that schizophrenic experience is misrepresented in Beautiful Mind. The fact that the course of John Nash’s illness was highly exceptional rather than typical (only about 5 to 10% of people with schizophrenia undergo permanent, spontaneous remission) is glossed over. The story, like the narrative in Shine, suggests that enduring love can win the day in this disorder. While no one doubts the importance of a caring family to provide stability and emotional support for schizophrenic patients, the implicit suggestion that love can conquer this disease is misleading in the extreme.

But, hey, Beautiful Mind is a “feel good” film. Spider, on the other hand, is murky and problematic. Like schizophrenia itself, this movie does not feel good. Dennis Cleg does not adapt well to change. He broods about old family dynamisms, real and imagined. He may not be taking his medication. He’s getting worse and no one’s the wiser. This is not an uplifting film, but it is frank and does not misrepresent the disease. I found Spider to be a richly imagined, keenly insightful, artistically brilliant milestone in the film depiction of mental disorder.

In the 1980s our contemporary culture of victimization emerged. Nearly a century after it was first invoked, trauma became fashionable again as an explanation for psychological misery. “PTSD” joined our ever more acronymous language. Rap groups, stress claims and sensational reports of sexual abuse multiplied. Hypnosis and provocative psychotherapies – wherein a patient’s “recovery” of traumatic memories was met with lavish praise from a therapist or group - were among the methods used to evoke recollections of remote childhood abuse. The national mood was bordering on hysteria about these revelations when, in 1987, Arnold Friedman, a popular high school teacher, and his youngest son, Jesse, then 18, were arrested on charges of sexually abusing 8 to 11 year old boys during computer classes they taught in their basement, in prim, respectable Great Neck, New York. The documentary film Capturing the Friedmans is a retrospective effort by Andrew Jarecki to cobble together a coherent story of what Arnold and Jesse Friedman did or didn’t do, and of the long lasting consequences of that dark time for the Friedman family.

Jarecki started out to make a documentary about clowns in New York City. This led him soon enough to “Silly Billy” - David Friedman, considered the number one birthday party clown in the city. They talked a lot. Friedman shared hours of old 8 mm home movies of himself as a child with his family, film shot by his father, who was quite a ham. The three Friedman boys also loved to show off on camera. Jarecki also interviewed their mother, Elaine, at length. Both she and David spoke of a blandly conventional family life. But there were hints that this might not be the whole story. Suspicious, Jarecki began to snoop around, eventually coming across the story of Arnold and Jesse’s molestation cases years earlier. Jarecki told David what he knew and said he wanted to make a different film, about the Friedmans’ family tragedy. David reluctantly agreed but later warmed to the chance of telling the family’s story from their (his) point of view. David then shared with Jarecki many hours of audio- and videotapes of the family made by him and Jesse at the time of the arrests, police investigation, and ultimate confessions of wrongdoing made by his father and brother.

In an interview on NPR, Jarecki has described how he wavered initially when faced with this newly disclosed, often shocking material. He was concerned about the ethics of making the reconceptualized film. Would it be right to use videos of private family conversations in a commercial movie? How might such a film affect the future prospects of family members – the Friedmans and families of boys had who acknowledged sexual abuse? Jarecki sought advice from Robert Coles, the esteemed Harvard child psychoanalyst and moralist, who has written extensively on the plight of disadvantaged children. After spending hours discussing the issues, Jarecki says that Coles advised him to move ahead. Jarecki and his editor, Richard Hankin, proceeded to weave a riveting, scrupulously nonjudgmental documentary, effectively mixing material from the Friedman tapes with interviews of others about the molestation cases, including Elaine, Jesse and David (middle son Seth refused to participate); Frances Galasso, who led the police investigation in 1987-88 and two other detectives who worked on the case; Abbey Boklan, the presiding judge, lawyers on both sides; a few of the 10 to 15 boys alleged to have been sexually molested, and the father of one; and Debbie Nathan, an investigative journalist who had covered other child molestation cases. Everyone has their say here; and there is virtually no editorializing or manipulation by the filmmakers.

This much is clear. Arnold Friedman was a pedophile. He kept hidden in his home pornographic literature featuring sex with youngsters. He received and even sent such literature through the mails, which was the beginning of his undoing, as postal inspectors caught up with him. He has said, in writing, that while a teenager he was involved sexually with his younger brother, Howard, over the course of several years. He has also written of sexual contacts with two young boys earlier in his adult life, before coming to teach at Great Neck. After months of steadfast denial of any sexual involvement with youngsters following the move to Great Neck, Arnold just before his trial precipitously reversed himself and pleaded guilty to a number of charges against him. He pleaded under considerable pressure from Elaine, who argued that this might disassociate his situation from Jesse’s and thereby lead to charges against Jesse being dropped. But this strategy failed. Jesse was charged.

Jesse also maintained his innocence until his trial was imminent, but at the last moment pleaded guilty, hoping this would shorten his sentence; again, it was a step Elaine strongly urged. David and Seth blame their mother for the imprisonment of their father and brother, and all that has followed. Arnold committed suicide by antidepressant medicine overdose while in a federal prison, in 1995. He may have done this in part to assure that life insurance proceeds went to Jesse, the sole beneficiary. Elaine had divorced Arnold before this and remarried in 1998. She and her second husband lead a quiet, apparently contented life. We learn near the end that Arnold’s brother, Howard, has been involved for many years in a stable gay relationship. Jarecki says that Jesse was released from prison just two years ago, after the film had wrapped, having served 13 of an 18 year (maximum) sentence. Under New York’s version of “Megan’s Law,” he must register as a predatory sexual felon, wear an electronic tracking device, and not live in a building housing children. He has faced several evictions when landlords receive an obligatory letter from the court about his status, and he cannot find steady work. Jesse alone among the brothers maintains contact with his mother.

It is also clear that there were distressingly discordant aspects to the police investigation. Galasso says there were stacks of child porn literature strewn visibly through the house. We can see that this is plainly not the case in old still photos shot when police first arrived to search. Interview methods used by police with the boys violated principles of unbiased interrogation of children that have been developed in research on the inducement of “false memory” and “false testimony” by forensic psychologists like Elizabeth Loftus. For example, a boy would be told by police that they knew he had been sexually abused in the Friedman basement, so why not talk about it, a blatant example of witness badgering. Another boy only recalled sexual involvement while under the influence of hypnotic suggestion: his hypnosis-driven testimony alone resulted in over 30 separate charges brought against Jesse Friedman. The details of charges were often at odds with the class schedule (classes met once a week, but some charges accused Jesse of sex on 41 different days in 10 weeks with the same boy). The lurid details police evoked, e.g., general disarray in the basement, blood and semen soaked underwear strewn about, are at odds with accounts of parents dropping in unannounced to observe classes or pick up their sons. Classes went on for years; students often signed up for more advanced classes after finishing an introductory course. Yet no child had ever said a word about sexual molestation until the police interrogations began. No trace of material evidence to suggest wrongdoing was ever discovered. The one father who was interviewed believes that the Friedmans were wrongly charged. Judge Boklan remains equally convinced of their guilt.

Viewers are challenged to capture the truth about these events and about the Friedmans. Jarecki has not made our task easy, and for that we should thank him. One might view the Friedman family as dysfunctional. Footage shot by David after the molestation case broke – scenes, for example, of family arguments about whether Arnold or Jesse should plead guilty, scenes on the night before Arnold goes off to prison, and when Jesse pleads guilty and later is about to go to prison – this footage captures people under the most incredible circumstances of strain and heartache. How would a “typical” family behave in such circumstances? The footage shot before 1987, when everyone was younger, supports Elaine’s perspective that once these people were, quite simply, a family.

Debbie Nathan says that families she has studied who are caught up in similar circumstances tend to act more cohesively in support of the accused member than the Friedmans did. But the Friedman case is complicated by Arnold’s documented pedophilia. This unavoidably opens the door to doubt and distrust, as articulated by Elaine. Though David and Seth have scapegoated her for it, I find Elaine’s doubt entirely understandable. David’s denial of the possibility of his father’s guilt is extreme. In one old video segment, around the dinner table, David point blank asks his father whether he did any of the sexual acts he has been accused of in the basement. But in a split second, before Arnold can even open his mouth to reply, it is David who says, “No!” He speaks preemptively for his father. And then he proclaims to the rest of the family, “There, you see, he didn’t do those things!”

I have formed my opinion about the case, i.e., whether Arnold and Jesse are guilty of the sexual molestation charges. You can reach your own conclusion. Jarecki was closer to these people than any viewer can be, and he says he isn’t sure. Any way you cut it though, this is a remarkably crafted film. It deservedly won the 2003 Sundance Grand Prize for documentaries.

I was aided in preparing this review by an interview of Mr. Jarecki, dated June 17, 2003, posted on the Internet atwww.themoviechicks.com (look under interviews) and another interview with him broadcast on All Things Considered, NPR, July 8, 2003.

GAMBLERS ON SCREEN? JUST A FEW WORTH BETTING ON(modified version of "Reel Life" column in Clinical Psychiatry News, February, 2004)

Gambling is on the rise. Legislators increasingly rely on lottery and gaming revenues to balance public budgets. Electronic poker machines are everywhere, and casinos continue to proliferate. William Bennett, America’s self-appointed Moralist-in-Chief, made headlines last May when his multimillion dollar gambling losses were revealed. Eighty percent of Americans now gamble at least occasionally; perhaps 1% to 3% are pathological gamblers, and treatment programs for them are sprouting up. Since films so often mirror other pop cultural trends, there ought to be some good recent movies about gambling, right? Well, in fact, there are few films about gamblers - new or old - and even the best of them can be tedious to watch, like movies about heroin addicts or hard porn. Some pleasures are just better in the doing than in the viewing.

Your basic script for gambling dramas unfolds like this. A gambler loses money he cannot afford to lose (it’s almost always a man, though a third of gamblers now are women). Next he becomes entrapped in a dialectic spiral of increasingly frantic efforts to borrow or steal money to bankroll ever more desperate gambling strategies (that inevitably fail), as he tries to keep a step ahead of his creditors, who are sometimes pretty nasty folks. The outcome is usually unpleasant - for the gambler and viewer alike. Maybe that’s why screenplays featuring gamblers are often built around more suspenseful, less relentlessly negative subplots, like confidence games (as in David Mamet’s House of Games) or heists (such as Neil Jordan’s recent The Good Thief). A British website catering to gamblers (www.thegoodgamblingguide.co.uk) provides reviews of no fewer than 34 feature movies with a gambling theme. But only a handful of these films offer in-depth, unvarnished portrayals of pathological gamblers. I have found just four worth reviewing here. If these films do not qualify as great dramatic successes, they do at least bring to life clinically plausible character studies of gamblers, in a series of vivid, varied portrayals.

If you want a stiff dose of pathological gambling, warts and all, without glamour or subplot niceties, Richard Kwietniowski’s recent film, Owning Mahowny, delivers the goods. Busy character actor Philip Seymour Hoffman plays Dan Mahowny, a successful young loan officer in a Toronto bank, who likes to bet on the ponies. He gets about $10K in debt to his bookie, who pressures him to pay up by refusing him more credit. Feeling cornered, Dan embezzles funds from the bank to cover his debt. Then, discovering how easy it was to take the bank’s money, he steals more to win back what he owes, wagering heavily at an Atlantic City casino. He rapidly slides into a vicious cycle of repeated losing and embezzling, a colossal “chase” of such eventual magnitude that he attracts everybody’s attention, from casino bosses to the police. Even his clueless, codependent girlfriend Belinda (Minnie Driver, looking dowdy in a long blonde wig) finally catches on that her man may have a wee problem.

Hoffman shows us three special features of Mahowny’s pathological gambling style. First, he is utterly joyless, applying himself with austere grimness at the tables, eschewing food, drink or the attention of others, showing neither pleasure nor pain when he wins or loses. He’s a card-carrying journeyman compulsive in action. He also displays serious denial. “I don’t have a gambling problem, I have a financial problem,” Dan patiently tells everyone. And he shows moral and interpersonal bankruptcy to match his financial woes. As in severe addictions, love, honor, loyalty, honesty – all pale before Dan’s need to keep on gambling. Near the end Belinda tells Dan that she loves him. She means it. When Dan replies mechanically that he loves her too, the chilling shallowness of his reply betrays his incapacity to love, a moment that defines Mahowny’s impoverished personality.

How clinically accurate is Hoffman’s depiction of pathological gambling? Tough question. I’ve been speaking of Dan Mahowny’s pathological gambling as if this disorder is widely accepted as a variant of OCD. Not so. DSM-IV lists pathological gambling in an odd little cluster called “impulse-control disorders not elsewhere classified,” shared with such odd bedfellows as trichotillomania and pyromania. There are equally convincing arguments for categorizing pathological gambling as either an impulse disorder or an addiction, according to a recently published report sponsored by the National Research Council ( Pathological Gambling: A Critical Review, National Academies Press, Washington DC, 1999). In my experience, which includes consulting in an outpatient gambling treatment program, pathological gambling comes in assorted flavors. The analogy to substance dependence is hard to resist, when behaviors like preoccupation, loss of control, and subjective symptoms suggestive of “tolerance” and “withdrawal” are prominent. For some gamblers, wagering is one element in an addictive melange that can also include alcohol, tobacco, drugs and sex. But for others, it is a matter of mood: gambling to escape depression or dysphoria, or during a manic episode. Some are “action junkies” - the drama and excitement of gaming counts most for them, though research has not shown that thrill-seeking is all that common among pathological gamblers. Antisocial and even criminal behavior patterns may be associated with persistent heavy gambling lifestyles. While OCD is not mentioned in the DSM-IV account, of interest are a few published reports that some gamblers with an OCD-like pattern do exist and may respond with diminished gambling behavior to medications for OCD. What separates compulsive gambling from most cases of OCD, of course, is that an extreme external stimulus (increasing debt) nips at the gambler’s heels, while the pressure for obsessive and compulsive symptoms in typical OCD comes from within, the result of psychological aberration or brain dysfunction. Who owns Mahowny, after all? Is it his inner demons or his gambling creditors?

Given the heterogeneity among pathological gamblers, it is fitting that the best movies about gamblers do not portray a common stereotype. In Karel Reisz’s 1974 film, The Gambler, James Caan plays Alex Freed, a popular college professor who is also a pathological gambler. Unlike Dan Mahowny, he is charismatic and highly impulsive. He articulates a sense of omnipotence that has been described as characteristic of some pathological gamblers. “I’ve got magic powers,” Alex says at one point when he continues to gamble despite mounting debts. “I’m scorching. I’m hot as a pistol.” He also speaks of his quest for excitement. “I like the threat of losing…I love to win, of course…but if all my bets were safe ones, there wouldn’t be any ‘juice.’ ” Freed looks sexy but, like Mahowny, he avoids sex. He’s not joyless, like Dan, but for Alex roulette and craps trump the pleasures offered by his girlfriend (a nubile Lauren Hutton).

John Dahl’s 1998 film, Rounders, is about men who earn their living by moving among high stakes poker games in New York City. Some, like Mike (Matt Damon), are impetuous and inconsistent; they win and lose big, and express contempt for the conservative pros who eke out a modest but steady living. Mike calls them “grinds” - like the character played here by John Turturro. Others, like Mike’s hotheaded buddy, “Worm” (Edward Norton), cheat. Now a reformed rounder, Mike attends law school, but eventually he returns to the tables to help Worm pay off debts and thus avoid serious bodily injury or worse. Mike loses his money, girlfriend and standing in law school, but in an odd twist, encouraged and staked to play again by one of his law professors, Mike gains confidence in using his ability to perceive subtle cues that give away the strength of other players’ hands (called “the tell”), and he begins to win more consistently. Damon is very good here; he gives wonderfully subtle shape to Mike’s gradually emerging confidence in his own ability to play straight and win. Whether his self estimate as a reader of people is justified, or simply another example of a gambler’s omnipotent fantasizing, is never entirely clear.

Croupier , made by British director Mike Hodges in 2000, is probably the best crafted drama among these films. Jack (Clive Owen, haunted and hungry here, like a young Laurence Harvey), a man literally born in a casino, son of a professional South African gambler and a former croupier himself, tries to shed his past by moving to London, where he wants to become a novelist. Strapped for cash and blocked in his writing, Jack reluctantly acquiesces when his father calls to say he's lined up a job for his son in a London gaming club. Back in the casino atmosphere, Jack finds himself pulled irresistibly into the amoral yet alluring life that permeates the club. He begins to violate rules forbidding fraternization with staff or patrons, especially after meeting two provocative women, one a mysterious gambler, the other a sexually bold dealer. To be precise about it, this film, like Paul Thomas Anderson’s Hard Eight, and the new film starring William H. Macy, The Cooler, is not so much the study of a gambler as it is a drama set in the gambling demimonde. But Croupier has a psychological depth that is lacking in most such films. It’s not as if Jack weren’t taking chances. He is gambling, but the stakes here are his integrity and his soul, not money. When Jack begins to write again, this time it’s about "Jake," an unprincipled croupier who represents Jack's darker side. Jack's internal struggle - between attempting to live up to the high moral standard he has set for himself versus the lying and cheating style of the inveterate gambler (his father’s style) - is the central story here. It is a well nuanced, psychodynamically intriguing quandary. External events intervene to make the ending somewhat helter skelter, but this doesn’t spoil the drama. The visuals are spellbinding. Mirrors are used ingeniously, and wonderful camera angles abound. The result is an atmosphere thick with the tensions and false glitter of casino life, made more real here than in any other film I can recall.

A RIDE ON THE FERRIS WHEEL(modified version of "Reel Life" column in Clinical Psychiatry News, March, 2004)

The story of Aileen Carol (“Lee”) Wuornos is a lurid tale. From her arraignment in Florida in 1990 - for killing seven men over a year’s span - to her trial in 1992, her case fed a national media frenzy. People ballyhooed her as America’s first female serial killer. Lots of folks hoped to make a buck from her story, even some of the police who caught her. Wuornos was convicted, and, in October of 2002, having exhausted all appeals, she was executed.

First-time writer-director Patty Jenkins has made the docudrama Monster, which tells a story of this psychopathic itinerant highway prostitute, who put as many as nine rounds into the bodies of seven johns with her pistol.

Aileen Wuornos’s background, pathetic and all too familiar, is well outlined by M. D. Kelleher and C. L. Kelleher in their book, Murder Most Rare:The Female Serial Killer (New York: Dell Publishing Co., 1999). Abandoned by her teen mother at age 4, she was reared by alcoholic grandparents. Her grandmother died when Lee was 15; her grandfather often beat her and eventually suicided when she was 20. She was a fire setter in childhood and bore facial scars from one fire that got out of control when she was 6. Wuornos became sexually promiscuous in early adolescence, was pregnant following rape at age 14, and on her own from age 15. For the 20 years before the first shooting, in 1989, she sold sex to survive, drifted, used aliases, committed crimes that included armed robbery and assaults, was hard drinking and brazen.

Wuornos was hardly the first female serial killer. The Kellehers provide information on 20 other women in the United States who killed multiple victims before Wuornos came along. But she was different. Most women acting alone who are guilty of multiple murders kill husbands, lovers, in-laws, children, or clients or patients they care for, and they almost always use poisoning or lethal injections. They usually don’t kill strangers and they don’t kill with guns, as Wuornos did. Women comprise less than 10% of serial killers in the United States, but women in the United States account for 75% of female serial killers worldwide. Wuornos claimed for years that her killings were all acts of self-defense, but on death row, shortly before her execution, she recanted this assertion. Other motives in Wuornos’s case probably included revenge (against men who had mistreated her through the years) and robbery.

We meet Lee Wuornos in the film shortly before her first killing; she is suicidal and alone. The film story spans about four years: from Wuornos’s initial meeting with a younger woman who will become her lover and ending with her conviction. It is difficult to know the extent to which Jenkins relied on her own imagination to augment or alter facts for her screenplay. The record shows that Wuornos and her lover were together for three years before the first killing took place, a lot longer than this film suggests. We also know from printed interviews with Jenkins that she corresponded with Wuornos and was lent a trove of Wuornos’s personal letters to review. Still, it is probably wise to consider Monster a dramatic interpretation of events in Wuornos’s life, rather than strictly as a docudrama. In any event, the film is well crafted, with excellent pacing, photography and story telling, a gem of a first effort by Jenkins.

What makes this film memorable, however, is the performance of Charlize Theron as Wuornos. It is unquestionably one of the most stunning turns by an actress that I can recall in film. Theron on screen has distinguished herself primarily as a gorgeous young woman with passable, though unplumbed, acting ability, poised somewhere on the cusp between starlet and star. I had seen her in several small roles: for Woody Allen in Celebrityand Curse of the Jade Scorpion, and most recently in the 2003 remake of The Italian Job. None of these performances prepared me for her personification of Lee Wuornos. Much has already been written about the cosmetic efforts required for her to resemble Ms. Wuormos. But that’s not the half of it. It is Theron’s acting that sweeps one away: her shambling gait and gangling gestures, the cocking of her head variously, the odd arching of her fingers holding a cigarette (in a manner often seen in persons with chronic schizophrenia), the frequent screwed up movements of her mouth and chin when she’s feeling some interior pain. Her raw speech, her hair-trigger temper, her grandiosity, her deep capacities for outrage and tenderness. She floods the screen with the power of her animus.

Christina Ricci does a splendid job as Selby Wall, the character loosely based on Wuornos's lover, Tyria Moore. Selby is depicted as an immature, self absorbed, passive-dependent, manipulative little naïf whom Lee attaches herself to, a fatal attraction that is at the ironic core of the story. This relationship and its consequences make a fascinating psychodynamic motif. The title “Monster” has dual meanings. Wuornos’s murderous rampage, though understandable in light of the violence repeatedly perpetrated upon her for years, is monstrous. But at one point she also tells viewers a story, in a voiceover, about her fascination as a youngster with a giant yellow Ferris wheel called “The Monster.” She was also afraid of it, and when she got a chance to ride, she reacted with fear, nausea and vomiting. She’s telling us that within her, underneath the masculine swagger, there is a terrified little girl, vulnerable and given to longings for things she cannot trust. It is Theron’s capacity to embody both the toughness and the fragility of Aileen Wuornos’s complex character that gives her performance stature. She wins our sympathies even as her behavior sometimes repels us.

Lee’s desperation misguides her judgment about Selby. Lee thinks her own hunger for love is matched by Selby’s. It isn’t. It can’t be. Lee’s trust in Selby’s love is based on projective identification, on an illusion: Selby is not capable of love, not at her age, not when her personality is so unformed. The tenuous bond Selby is able to establish soon starts to fray as she catches on that Lee’s behavior is poorly controlled and that she may be involving both of them in a spiral of serious crime.

The supreme irony here is that big, tough Lee is operating at a more immature level of development than quaking little Selby. Lee relies on coping patterns more characteristic of troubled young children: she’s quick to withdraw from people or escalate into angry outbursts unpredictably, often in public; she brags and displays near manic grandiosity at times; her physical manner both warns against and invites the prospect of aggression; she shows the tendency to take quick, impulsive action to solve a problem or reduce tension; she resorts to escape fantasies to ward off dysphoria.

Lee’s childlike nature is brought to our attention in the very first scenes, a series of photos of a happy Lee, between about ages 5 and 7. In accompanying voiceovers by the adult Aileen, she tells us that “I always wanted to be in the movies…I dreamed about it for hours…Later, when I was down, I’d escape into these thoughts.” At one point, Lee tries to find a regular job. Again, there is a childlike quality to her plans: “I’ll get a career, we’ll have a house, a car…I’ll be a veterinarian, I love animals…Maybe I’ll be a business person. Hey, I’ll be President of the United States.” Her naivete is astonishing: she interviews for jobs guided only by platitudes recalled from an inspirational speaker she once heard at school: “All you need in your life is love. And to believe in yourself.”

Selby, on the other hand, uses strategies more befitting a troubled adolescent. She’s demanding, pouty, manipulative, dependent, self-centered and a worry wart, understandably frustrated and fearful when Lee’s conduct becomes more erratic, after she has killed the first man, an act unequivocally portrayed as self defense in the film. Compared with Lee’s explosive bag of maladaptive tricks, Selby’s tactics are in fact more mature and less dangerous ways to react to and try to solve problems. Selby is worried from the get-go about throwing in with Lee, though her libido and craving to be nurtured, to be protected and made strong by linking herself to a seemingly stronger woman, overcome her misgivings at first. Selby does grow more frightened the deeper the mess becomes, even as she compounds the problem by more desperately escalating her demands that Lee do something else to rescue them. When Selby finally recoils for good, it is a matter of self protection, not a betrayal of love. And much as our sympathies lie not with her but with Lee, how can one argue against Selby’s horrified withdrawal? How do you throw in for life with a psychopathic lover who kills for the rent money? What would you do in her place?

For her part, Lee lets down her guard: she chances a ride on the metaphorical Ferris wheel of intimacy, she allows herself to experience tenderness in what she hopes will be a safe, requited love relationship. And once she does open her heart, paradoxically she can no longer tolerate the johns she continues to hustle. That’s when the gratuitous killings begin.

Documentarist Nick Broomfield has made two films on Wuornos, one that I have not seen, Aileen Wuornos: The Selling of a Serial Killer (released in 1992, the year of her trial) and a new one that I have seen and reviewed, Aileen: Life and Death of a Serial Killer (including death row interviews shortly before her execution, released in 2003).

THE "TRICKY INTIMACY" OF PSYCHOANALYSIS(modified version of "Reel Life" column in Clinical Psychiatry News, April , 2004)

In the film Empathy, both documentary and fictional approaches are used to examine what director Amie Siegel terms the “tricky intimacy” that exists between psychoanalysts and their patients. Empathy is far from being a mainstream film, but the ingenious, probing manner in which the filmmaker approaches her subject makes the film an important one to see for psychotherapists of every stripe. Ms. Siegel, who also wrote the screenplay, is a poet and visual artist who is interested in spectatorship and its reciprocal, how people represent themselves to others. The psychoanalytic situation is rich soil for examining these interests, since both analyst and patient typically, perhaps always, represent themselves in special ways, subject to special constraints and modes of withholding. They role play.

Classical psychoanalysts tend to adhere to Freud’s technique of minimizing disclosure of personal information, in order to facilitate the development of the transference. The down side of this approach is that by withholding personal responses, the analyst may appear to be uncaring, callous, dismissive or unreal. Appearing as a “blank slate” may even do harm when patients need a psychotherapist to be a real person, one who engages them with more spontaneity and candor. Contemporary psychoanalysts are often inclined to work in a more interactive, give-and-take manner. The analyst is also a privileged spectator, given a front row seat from which to scrutinize the patient’s most intimate feelings and thoughts. Patients, for their part, may consciously or unconsciously falsify or withhold information about themselves and their relationships for any number of reasons: fears of embarrassment, humiliation, rejection, punishment, guilt or loss of control, among others. These are the issues that Ms. Siegel takes up in Empathy.

To examine these matters, Siegel intermixes footage of four sorts: interviews with psychoanalysts; a dramatization of psychoanalytic treatment; the process of making this film; and a segment about the relationship of psychoanalysis to modernism, focusing on architecture and the Eames lounge chair, said to be a favorite among analysts. The film opens with the camera on a huge, empty, red leather upholstered chair – not an Eames. We hear a man’s voice off screen and infer that a psychoanalyst is on the phone, reassuring an anxious patient. The call ends; the analyst walks into the picture and slouches in the chair before us. He is one of four psychoanalysts interviewed by Ms. Siegel during the film. Two are identified by name, but the other two are not; they declined to be named in the film.

Ms. Siegel, off camera, poses these questions to each analyst: Do patients lie to you? Do you ever lie to them? Is there an element of performance in your conduct as an analyst? Do patients also role play in treatment? Given the fact that one party pays for a relationship with another in analysis, are there analogous transactions? Is analysis in this sense like prostitution? Does the analyst’s own voyeurism motivate interest in his work? Is empathy a spontaneous response by the analyst, or a more measured, calculated substitute? Do psychoanalysts find more meaning in relationships with their patients than in the world outside the office? Have you ever had sex with a patient? What are the limits of confidentiality? The responses the analysts give to such questions are far ranging and, for the most part, convincingly candid.

Interspersed with segments from these interviews is the fictional drama in which a depressed woman, Lia (played by actress Gigi Buffington), an aspiring actress, seeks help from a psychoanalyst (played by one of the analysts). We see Lia in several settings: at work as a reader for an audio book, having dinner with her sister, lap swimming, and during several analytic sessions. In the analyst’s office, Lia typically sits on one side of the backless couch, looking rather uncomfortable (in one session, after awhile, she does lie down). Near the end of a session, she confides that when she has sex with a man, she sometimes imagines the analyst in the room watching. The analyst responds that their time is up for today. At the start of the next session Lia says she wants to transfer to a different analyst. Invited to share her reasons, she says she felt cut off, uncared for, embarrassed, by the analyst’s response to her disclosure at the end of the previous session. The analyst replies that there is a pattern, that Lia tends to bring up important topics at the end of sessions, when there’s no time to examine what she’s said. He goes on to offer an interpretation of Lia’s sex fantasy. At one point Ms. Siegel approaches the analyst in the parking garage and asks how Lia is doing. He refuses to answer. When Ms. Siegel presses him, saying that, after all, Lia’s therapy is a fictional dramatic arrangement, he replies that it doesn’t matter, i.e., he stays in role by insisting on confidentiality.

The third element interspersed through the film consists of behind-the-scenes shots about the making of this movie. There are auditions for the role of Lia., scenes shot from the perspective of the camera operator, i.e., through the view finder, showing a grainy field and black lines framing the shot as it will appear on taped replay. Microphone booms are purposely exposed; a grip walks across the camera’s view to place articles on a table before a shoot. Late in the film Ms. Siegel appears, discussing why she is making the film. We attend a cocktail party where the actors, psychoanalysts and film crew all chat it up. A fourth element is an inquiry into the connection between psychoanalysis and modernism. Architects Philip Johnson and Dion Neutra discuss how modern design is often concerned with minimizing the boundary between interior and exterior spaces, e.g., through the use of large glass panels. An analogy is suggested between such designs and the psychoanalytic goal of reducing the boundary between unconscious content and consciousness.

This film as a work of conceptual art: it is devoted to the examination of a central idea, the dual human tendencies to establish boundaries - barriers, limits - and also to dissolve or overcome them. We are all, as Shakespeare said in As You Like It, really actors on a stage. The psychoanalytic situation provides a good vantage point to observe this: patients adhere to their personas and cherished personal narratives, however much they might distort reality, while analysts also pose to varying degrees according to the technical dictates of their particular school. But there are always forces at work seeking to break down, to set aside the very boundaries that fortify and protect us in our established roles. The desire to diminish interpersonal boundaries may be a modern trend, as Ms. Siegal suggests. In earlier generations more emphasis was placed on saving face, preserving dignity and reducing frictions among intimates, through deception, family myth making, role playing, withholding, lying. The advent of psychoanalysis and psychodynamic psychotherapies may reflect a larger cultural movement over the past century in the direction of reducing the barrier between what we experience and what we disclose to others.

Of course there is an irreducible boundary between people. One cannot directly know the experience of another, try as we might. Empathy - that process whereby we try to match something we’ve felt or encountered with what another person is telling us - is as close as we can get to that person. Because we share common substrates of brain function and exposure to life’s most critical events – birth, death, illness, loss, empathy is often achieved. When it isn’t, when the therapist cannot establish emotional resonance with the patient, this failure of empathy is always significant. It may alert the therapist to inadequately examined diagnostic or countertransference issues, or suggest more of a cultural divide between analyst and patient than was suspected.

In the otherwise puzzling elements of which this film is woven, we can upon reflection discern many instances where Ms. Siegel is demonstrating ways in which boundary issues play out: the boundary between analyst and patient; between what is hidden and what is revealed; information that is confidential versus that which is not; role playing versus reality; inside the womb or parental bedchamber vs. outside such quarters; fictive versus documentary accounts; filmmaking versus film product. The final scene is telling in this regard. There is a man in Dr. Solomon’s waiting room seated next to Lia. She enters the analyst’s office and her session begins. The man in the waiting room goes up to the closed office door and puts his ear to it.

Empathy is not without flaws in composition and editing. In one scene, the camera seems to stray aimlessly along a wall for no apparent reason. The blurry corridor surveillance scenes are merely puzzling. We don’t need to see Lia’s swimming pool twice. The Eames chair sequence is amusing, but it concerns analysts’ power more than boundaries. A less complex, less convoluted structure would make the film more comprehensible to people who know nothing about analysis, but the risk then would be pedantry. As it is, this film is richly imagined, and it makes you think; its scenes linger in the mind. It is a provocative, sometimes humorous, useful excursion into the world of therapy. It tears away some of the mystery surrounding analysis, but stops short of being disrespectful. Mental health professionals and patients will find this film absorbing, troubling, stimulating. It’s a wonderful trigger for discussion or training. I am less certain of its reception by general audiences, who may be as dumfounded by it as they are edified. The owner of the theater where I saw the film said it bored him the first time through, but he was intrigued enough to watch it a couple more times, and, on each occasion, he found the film becoming more and more interesting.

ROOMS IN THE HOUSE OF GRIEF(modified version of "Reel Life" column in Clinical Psychiatry News, May , 2004)

Bereavement is the central theme in several recent noteworthy films. I want to discuss three of these movies that illustrate how grief indeed has many faces. In each of these films, a vibrant young person dies unexpectedly, and we follow the families through their suffering after loss. Moonlight Mile andIn the Bedroomcan perhaps be regarded as quintessentially American, for they share a subtext of violence and, unsurprisingly, the vicissitudes of grief we witness are colored by bitterness and the desire for revenge. And yet the survivors employ different psychic strategies to carry on. The Son’s Room, from Italy, tells a simpler, gentler story of uncomplicated bereavement.

The underappreciated Moonlight Mileis based on experiences of its writer-director, Brad Silberding, whose fiancée, an actress, was killed by a fan in 1989. During the years that followed, Silberding grew close to her parents (the decedent’s father is a clinical psychologist). The film opens three days after a crazed man has accidentally shot and killed Diana at a local coffee shop, while attempting to shoot his estranged wife, a waitress there. We meet Diana’s fiancé, Joe (Jake Gyllenhaal) and her parents, JoJo, a writer (Susan Sarandon) and Ben, a real estate broker (Dustin Hoffman), as they dress for the funeral. We then follow these three people over the next few hours and days, then more fleetingly over subsequent weeks and months (one of this film’s finer accents is this shift in the pace of time from slower to faster as the story unfolds - changes in tempo that mirror the cadences of grief itself). Joe and Diana had planned to marry and settle in her hometown; the wedding invitations were already in the mail. Joe was to join Ben in business. But circumstances under the surface belie this rosy picture. Convolutions in Diana’s relationships to each of the three survivors are gradually revealed. Joe finds solace in the company of another young woman who is also grieving a loss. Mile focuses on contradictory emotions (sadness and silliness, as well as vengeance) and the socially awkward nature of grief. As Roger Ebert so aptly put it in his review of the film, “Death is the ultimate rebuke to good manners.” Friends blurt out inanities in their well intended but futile efforts to offer emotional support, and, partly in response, when, for example, the family privately ridicule some of the guests, they discover the surprising balm of humor in the midst of pain. Some viewers find such satire unsettling. A highly sentimental woman I know, still grieving the loss of her mother several years ago, was offended by this film. Contrarily, I was reminded of the hilarious anecdotes my brother and I shared about our father on the day of his funeral, long ago. Granted, the edge in some of JoJo’s levity no doubt represents her anger about her daughter’s murder. But such humor typically represents neither denial of loss nor disrespect (of the deceased or the funeral guests). Rather, it is a counterpoint, a purchase of moments of respite, to ease the burden and ward off the numbing effects of loss. Surely this is reaction formation and positive reminiscence put in the service of the ego. It is the special strength of this film that it explores and confronts such themes head on.

In the Bedroom, made by writer-director Todd Field, concerns a comfortable, middle aged, small town couple, Matt (Tom Wilkinson) and Ruth (Sissy Spacek). Matt is a family physician. Ruth teaches music at the high school (among the film’s highlights are scenes in which Ruth is rehearsing a girlchoir singing Balkan folksongs). Frank, their 20 year old son and only child, begins a summer fling with Natalie, an older woman and mother of two small children. Frank is later shot to death by Natalie’s violent, estranged spouse, and Matt and Ruth are left psychologically in shambles. Ruth appears nearly paralyzed by depression, then, progressively, her passions turn toward rage against the murderer. Matt, on the other hand, tries to hide his grief, buck up and continue his practice with a brave smile. Privately though, we do witness his sadness, accentuated when Ruth distances herself from him. His efforts to carry on as if untouched not only fail to support Ruth but backfire, further aggravating her rage. After months of silence, they finally exchange heated accusations in a single cathartic encounter, revealing the longstanding resentments each harbors toward the other. And though this argument does not restore intimacy between them, it does forge their common desire for retribution. A rapprochement of sorts has occurred, and however dark its intentions, Matt and Ruth’s new alliance does animate them, at least in the short run. Bedroom authentically demonstrates several complications of grief. Clinical depression, as in Ruth’s case, is strikingly prevalent after the death of a loved one. Matt’s attempt to gloss over his own mourning and appear unperturbed is also a common coping style. I have treated parents of murdered children and can attest that this film’s representations of surviving parents’ rage toward the killer ring true. This could have been a film awash in bathos, but instead, while violent, it is also a compassionate, suspenseful work. The acting of all the principals, and Field’s willingness to let the viewer imagine the full unfolding of key scenes left unfinished, contribute to Bedroom’s power.

The Son’s Room was written and directed by Nanni Moretti, who is regarded as a master of offbeat comedy and often referred to as Italy’s Woody Allen. Moretti casts himself here as Giovanni, a psychoanalyst and head of a genuinely happy family: spouse Paola and two teenagers, daughter Irene and son Andrea (Paola and Irene are in fact played by Moretti’s wife and daughter). Life moves cheerily along for the first half hour, filled with family activities and humorous encounters between Giovanni and his patients. (He is flexible and empathic in his work.) Then one gorgeous, lambent day, Andrea drowns in a diving accident, and Giovanni’s world is transformed by loss and mourning. The grief the family expresses is measure-for-measure a counterpoint to the normal life they had lived beforehand. Bereavement here is free of the sorts of vicissitudes seen in the other films. There is no pathology, no histrionics, nor humor in their suffering: no malignant depression, rage, acting out, or facade of cheerful denial. The contrast with the other two films tends to bear out Freud’s impression, discussed in “Mourning and Melancholia,” that complicated bereavement occurs when there are deep conflicts in the personality or family (or, one might wish to add, when the circumstances of the death, as in murder, unavoidably engender conflict.) Giovanni and his family, on the other hand, quietly cry, look burdened with somber sadness, visit in simple bewilderment the empty, unanimated bedroom that was Andrea’s personal space. Expressions of grief come in waves, an ebb and flow that is entirely natural and realistic. The gentle grieving of the family is supported by a pensive musical score. Giovanni blames himself: if only he hadn’t agreed to see a patient in crisis that fateful morning, he would have been with Andrea, the diving trip postponed. He notices cracked and chipped pottery in the kitchen and says he feels broken like them. Searching for some stimulus that can break through his numbness, at one point he finds himself riding a roller coaster. He becomes less attentive to his patients, more caught up in his own emotions than in theirs, and decides to disengage from his practice for a while.

The ending is unexpected. Andrea’s diary refers to a girl he had met recently. Paola calls her, hoping to arrange a visit, but is rebuffed. Later this girl does visit, without prior announcement, apologizing for her earlier response. She has a boyfriend in tow. They are heading off on a trip and just stopped by to pay their respects. Giovanni offers to drive them part way to their destination for the day. Paola and Irene tag along. Everyone gets along comfortably. The fivesome reach the intended bus stop, but Giovanni doesn’t want to see their time together end so soon, so he offers to take them farther. This sequence gets repeated until they finally reach a ferry debarkation point for the young couple. Over the course of the trip, on another lovely, sunny day, the family’s mood seems to lighten for the first time since Andrea’s death. When they arrive at the ferry terminal, there is a subtle buoyancy in Giovanni, Paola and Irene. They decide to stay overnight, extending their visit in the little town, after the young couple take their leave. The film ends on this note.

It makes psychodynamic sense that the family could begin to solve its grief through the serendipitous visitation of these surrogates for their son. Like Andrea on the day he drowns, the young couple’s journey will take them away, most likely never to be seen again by Giovanni and his family. But in this instance, the family gets to stay with them until the separation, in fact controls the departure, delaying it as long as possible, by the act of conveying the young couple to the ferry. This is an enactment of mastery over what had been an unbidden event that befell the family, rendering them helpless victims as their son had also been a victim. Giovanni, Paola and Irene take an active hand in facilitating the departure of the surrogates. The family can be with the young people ‘until the end.’ They can say goodbye. And through these acts a kind of psychological magic takes place: mastery of the circumstances of ‘loss’ of the surrogates alters the impact of the original loss of Andrea. Such repetitious acts have power because of their symbolism: a tangible object or act stands for another, less tangible. This auto trip is a sacramental journey. And from it a lightening of the burden of grief ensues. Hope returns. Grief will continue to ebb and flow, but a change in direction for the better is in store. The ending here rings true spiritually and psychologically. This is narrative genius.

MORE ROOMS IN THE HOUSE OF GRIEF(Web supplement to "Reel Life" column in Clinical Psychiatry News, May, 2004)

Grief indeed has many faces. In my “Reel Life” column in the May, 2004, issue of Clinical Psychiatry News (the column appears in the "Opinion" section, p. 24) I discuss several portraits of bereavement depicted in the films Moonlight Mile, In the Bedroom and The Son’s Room. Here are four more. In About Schmidt, co-written and directed by Alexander Payne, Jack Nicholson plays a sad, empty man whose life has been devoted more to the insurance business than to his family or his own needs. Newly retired and already at loose ends, he comes home one day to find his wife of 42 years sprawled dead on the kitchen floor. The film follows his odyssey over the ensuing months, a bumpy course during which Schmidt’s loneliness and dependency shape his erratic behavior. He tries to sabotage his daughter’s wedding plans. Granted, he has reason to wonder whether she will be happy, marrying into a family sunk in ‘60s hippiedom. But his more selfish motive is to persuade her to take care of him, not some doofus from Denver. He hits the road in his huge new RV, planning to pluck her from the arms of her intended. Along the way, after a couple of beers, he makes a pass at another man’s wife, another act impelled by his neediness, and one that seems to shake Schmidt into some inchoate realization that things are amiss within his soul. I once had an aging patient who reacted to his wife’s death by drinking hard and trying repeatedly to seduce her identical twin spinster sister. Needless to say, this caused quite a family stir. Schmidt is real to its core, and Nicholson offers one of his best turns ever.

Under the Sand is a French film by Francois Ozon, in which the enigmatic, alluring Charlotte Rampling plays Marie, a literature professor contentedly married for 25 years to Jean. On their accustomed seaside vacation, while Marie dozes on the beach, Jean goes swimming but disappears. We follow Marie over the next two months. She seems tense but otherwise ostensibly normal. She shows no trace of grief. She lectures, attends dinner parties, even dates a man her best friend has introduced to her. But at night when she returns home she finds Jean there, welcoming her. They talk together, and she feels comforted by his presence. When she chats with her friends, she refers to Jean in the present tense (e.g., "Oh, I should ask Jean about that."). She never sees him away from their apartment. When police recover a body several weeks later, Marie declines to identify the remains. Finally, two weeks later, she tells Jean’s mother she fears he may have suicided. (There are hints she might be contemplating this herself.) Finally she does visit the authorities but denies recognizing swim trunks and a wristwatch, even though they precisely match descriptions Marie herself had given the police. As the film ends, she returns to the beach where Jean drowned and cries deeply for the first time. Then she glimpses a man’s figure in the distance, runs toward the figure, slows, but does not make contact as the last scene fades.

Marie's denial of Jean’s death is obvious and not uncommon as a fleeting, sometimes recurring response early in bereavement. A surviving spouse often will sense the presence of a lost loved one now and again for months, even years, after a long marriage. Formed hallucinations of the deceased could suggest something more serious, a psychotic depression or brief reactive psychosis. But such phenomena can also be more benign dissociative experiences that come and go. I knew a 98 year old woman - neither psychotic, demented nor prone to delirium - who, in the last year of her life, reported regular vivid bedside visits from her long deceased husband and, on other occasions, from her mother. These visits were a comfort to her, as Jean’s visits are to Marie. At the end of the film grief finally breaks through Marie’s denial and her hallucinations of Jean begin to fade – he’s way down the beach, not at her side. Sand is a brilliantly realized story.

In Todd Louiso’s film, Love Liza, the ubiquitous character actor Philip Seymour Hoffman is cast as Wilson, a grief stricken man in the wake of his wife’s suicide. He resorts to sniffing gasoline and becomes more and more dysfunctional, casting aside his excellent job, railing angrily against his mother-in-law (Kathy Bates), well meaning friends and store clerks. He discovers a suicide note addressed to him but won’t read it. Things do not get better. His mother-in-law retaliates by having all his household goods removed. Wilson forfeits a promising new job opportunity. The notion of a white collar adult developing a gas sniffing addiction is quite unlikely. Gas sniffing is a serious problem among young teenagers, especially in certain ethnic minorities, in Canada, the U.S. and elsewhere. Substitute alcohol for gasoline, though, and the story might fit thousands of bereft men. Wilson learns nothing, achieves nothing beyond his own misery and the angry flak he gives back to those who try to help him. Such wasteful pathos can overcome vulnerable survivors not only of a suicide but any loss of a close loved one.

That said, suicide does tend to leave especially indelible marks on survivors. Edwin Schneidman, the famous suicidologist, observed that suicide “poisons the well.” He meant that suicide leaves surviving loved ones with an especially onerous burden of guilt and foreboding. Their own suicide rates are above average. Even among mental health professionals, when a patient suicides, we tend to blame ourselves, as if suicide is always the preventable result of someone else’s neglect or failure to provide for the unfulfilled needs of the deceased. The film does depict this sad scenario with poignancy. The role of Wilson was written for Hoffman by his brother, Gordy Hoffman, whose screenplay won the Waldo Salt Award at Sundance.

For the film In America, Jim Sheridan, the Irish writer-director (My Left Foot, In the Name of the Father), and his two grown daughters, also writers, have prepared a story based on their shared personal tragedy of losing a son and brother, Frankie, in childhood. In this story, an Irish family moves first to Canada. Then, after their son Frankie succumbs to a brain tumor at age 5, they move again, this time to New York City, partly so the father, Johnny (Irish actor Paddy Considine), can find work as an actor and partly to escape the tragic past. They find an affordable apartment in a dingy multistory walkup that houses an unseemly assortment of drug addicts, transvestites, immigrant families and madmen. They struggle to settle in. Johnny’s wife Sarah (Samantha Morton) and the couple’s two daughters, 11 year old Christy, who narrates some of the story, and 8 year old Ariel (played by sisters Sarah and Emma Bolger), are coping pretty effectively, they’re more prepared to move on, open to the new possibilities of life in America. But for Johnny, as they say, the “geographic cure” isn’t working. He’s no better off in New York than before. Johnny blames himself for Frankie’s death; he was tending to the children the day Frankie fell down stairs at age 2 and still thinks this caused the tumor. His grief is entrenched and unyielding: it saps his energy, blocks his ability to act and prevents him from full emotional engagement with his family.

We meet the catalyst for change in Johnny and his family’s fortunes on Hallowe’en, in what must rank as one of the most entertaining trick-or-treat encounters on film. Mateo (Djimon Hounsou, from Benin), a fierce African artist, lives on the floor below. We’ve caught glimpses of him earlier, writhing in nocturnal frenzies, using his own blood to make drip paintings. He’s an exotic wild-eyed loner. But when the girls will not stop knocking on his door on Hallowe’en, despite his shouts for them to go away, he yields. Thus begins a fast and hearty friendship between Mateo and the family. Despite the fact that he is dying, Mateo is able to touch each of the four, even, in the end, Johnny himself, although he is the most reticent at first. This film moves fitfully, its pace is uneven, a series of lulls and bright moments, near stalls and restarts. Hounsou radiates charisma and electrifying energy, far too much for a man who's dying. And his overnight transformation from isolated madman to sweetie pie/sugar daddy is more than a bit much. The idea that this vital force of nature can pass on his zest for living to Johnny and the others is a wonderful idea for a film story. But here it remains primarily just an idea, one not fully or convincingly realized. A strength of the film, nevertheless, is it’s compelling demonstration of the impact of loss of a child on the family, and the impact of a parent’s bereavement-associated depression on his own functioning, at work and at home.

The film world was diminished by the death of Sir Alan Bates in late December, shortly before his 70 th birthday. Although Bates offered several turns of greater stature during a long career, I shall always vividly recall him as Charles Plumpick, the bemused Scot soldier in Philippe de Broca’s 1967 antiwar fantasia, King of Hearts, a film with loose ties to hospital psychiatry. I recently revisited this film to pay my respects. Pvt. Plumpick looks after carrier pigeons for his World War I infantry unit. He knows about ornithology, not ordnance, but he can speak French. These credentials are sufficient, in the view of his dimwitted commanding officer, to justify dispatching Plumpick to defuse German time bombs meant to blow up a strategically located French village. The villagers had also got word about the hidden bombs and eloped along with the retreating Germans, abandoning the town to the inmates of a local insane asylum.

Plumpick arrives, inspiring the patients to venture forth. They don brilliant, conveniently available period costumes that match either their real or delusional identities: one’s a duke, another a prostitute, another a priest, a hair stylist or a general. There’s even a circus left behind, with an elephant and bear to turn loose. For the rest of the film Plumpick, having traded in his kilt for a natty shepherd’s plaid suit, alternates between the role of beguiled cheerleader for this decorous group and that of the occasionally fretful, luckless bomb sleuth.

The patients, for their part, stage a perfectly delightful non-stop party over the next 24 hours, full of pranks and pageantry, all carried off with dazzling talent and not a trace of mental instability. Plumpick finds the bombs in the nick of time, but then Scot and German detachments enter the town and shoot each other up in 18 th Century point blank style. As the villagers return, the patients see that the jig is up, shed their party garb and retreat, not without sadness, to the hospital, carefully locking the gates behind them. In the final scenes, Pvt. Plumpick joins them, arriving buck naked at the front gate, bearing only his cage of pigeons, to be let in by the nurses, now firmly back in charge.

The message of King of Hearts is simple enough: war is insane. The film’s conceit is to expose a society gone mad by contrasting it with the mental hospital, portrayed as a safer place to take refuge. The notion of mental patients acting more sensibly than others about war was refreshing and resonant, even if it did require suspension of disbelief, to those who opposed our escalating military involvement in Vietnam 37 years ago.

Nearly two generations on, war is still very much with us, and another film that reprises the themes in King of Hearts has arrived from Russia, House of Fools. It’s an anti-war drama loosely based on real events in 1996 at a psychiatric facility somewhere on the Chechnya-Russian border, shortly before the first cease-fire in the war between these forces. The hospital is old and understaffed, run by a kindly, diligent psychiatrist. The ‘patients’ are a mix of actors and authentic chronic inpatients: a man wheelchair bound with severe cerebral palsy; another with severe contractures from sitting neglected for too many years, who hobbles along in a near seated posture; a woman with Down Syndrome; an old man with psychotic depression who needs tube feedings; sundry others.

Among the actors, three stand out. Vika (Marina Politsejmako) is a stout older woman, a communist of the old school, a somewhat manicky, officious sort who loves to bully others. The two central patient characters are Janna and Ali. Janna (Yuliya Vysotskaya) loves music. When she plays her accordion, often at times of tension on the ward, the music ignites her fantasies: the ambient light glows warmly sunny, and she imagines everyone singing and dancing gaily around her. She also has a fantasized love relationship with her favorite pop singer, Canadian Bryan Adams. Adams (playing himself) often appears to Janna – whether these are internal fantasies or frank visual hallucinations is uncertain. Janna also helps look after other patients in her nervous, hummingbird style. Ali (Stanislav Varkki) is a diffident, blunt schizophrenic poet. But he is also a respected natural leader among the patients; even the formidable Vika demurs to Ali’s orders. Life clamors along, never dull but, given the patterned eccentricities of its citizens, more-or-less routine and predictable, as befits a typical chronic ward.

And then one day all Hell breaks loose. The trains stop and the phone goes dead. Both nurses flee to their homes. The doctor goes off in search of buses to evacuate the patients. Artillery explosions rock the hospital. War between Muslim rebels and the Russians has arrived, uninvited. Rebels occupy the hospital. The patients are scared witless but then things quiet down. The soldiers now simply dig in to rest and wait. They are mainly good natured.

As in most films about the Bosnian war, small ironies abound here too. One rebel wears a Calvin Klein logo T-shirt under his flak jacket. Two others trade marijuana for ammunition in a deal with Russian soldiers during a temporary truce. The rebel commander and a Russian tank officer discover that they had fought together in Afghanistan. A running joke develops among the rebels that one of them, Ahmed, wants to marry the attractive Janna, who takes this notion seriously, anguished at having to renounce her (imagined) betrothal to Bryan Adams in order to give herself to Ahmed.

After a few days, a Russian counterattack erupts. Artillery, a helicopter gunship, tank and foot soldiers invade the hospital grounds. The rebels scatter: most leave, a few hide inside. Janna, histrionic, joins other patients hiding in the basement. Finally the doctor returns. He restores order and also treats a Russian captain for acute stress disorder (he swears the doctor to secrecy about his need for help). At the end Ahmed - the only rebel still alive on the grounds - turns up in the dining room, masquerading as a patient to avoid detection (a ploy Pvt. Plumpick had also used). The others provide him cover. He is safe. Janna is pleased. No patient has died.

When used in a geopolitical context, the term ‘asylum’ has always carried a positive meaning of safe refuge. When we speak of asylum for the mentally ill, however, different images come to mind. Whether positive or (much more typically) negative, most views are simplistic. The theme implicit in King of Hearts – that mental illness is an eccentric yet sane strategy to cope with dangerous forces set loose in the world - was thoroughly worked over in novels, plays and movies, as well as in the professional literature, throughout the 1960s and beyond - to the point of becoming clichéd by the end of the 70s.

For example, Mike Nichols’s 1970 film Catch-22, based on Joseph Heller’s 1961 best selling novel about airmen in World War II, pushed an ironic idea to its logical extreme. At a time when there were insufficient forces available (shades of Iraq), men were becoming mentally unhinged from the stress of flying combat missions too frequently; at the same time, anyone who asked for hospitalization, for treatment, obviously displayed good judgment, proving he was not mentally ill and thus capable of continuing flight duty. Sidney Lumet’s 1977 film Equus, adapted from Peter Shaffer’s 1973 play, extended this notion to the everyday world: Richard Burton, as the psychiatrist, laments the insane world that drives his young patient to seek refuge in mental illness, a saner alternative as Burton’s psychiatrist sees it. The idea of illness as a twisted strategy to maintain sanity among even more irrational family members had been introduced in the 1960s, in the writings of the maverick British psychoanalyst, Ronald Laing.

On the other side of the argument, Milos Forman’s 1975 hit movie, One Flew Over the Cuckoo’s Nest, suggests that some patients seem all too ready to voluntarily abandon their freedom for the security of the asylum, paying a stiff price in the bargain: loss of individual initiative and entrenchment of disability. Still others remain confined without any say in the matter. Years earlier, in an inversion of the theme in King of Hearts, when German bombing destroyed parts of several British mental hospitals early in World War II, many patients went unaccounted for. They didn’t show up at other hospitals, injured or otherwise, or on lists of the dead. After the war a research team sought to track them down. Most were indeed still living and doing well enough, thank you. They had adjusted to life away from the hospital, first out of necessity, later because they felt sufficiently satisfied living in the community.

Such findings lent credence to a trend in psychiatric thought that gathered strength during the 1950s and 60s: in many cases prolonged hospitalization was often both unnecessary and deleterious. Yet we’ve learned subsequently that simply closing public asylums for the mentally ill without properly funding decent alternatives has too often led merely to newer forms of warehousing: in bleak group homes and even bleaker jails.

Compared to King of Hearts, House of Fools offers a far more starkly realistic view of both the handicaps of the chronic mentally ill and the harshness of war. This is a sharp edged film, no doubt better suited to our times and sensibilities than the amusing parfait served up in King of Hearts. In House of Fools, clear and simple boundaries no longer exist. War bursts into the hospital. A commanding officer becomes a furtive patient. Soldiers on the two sides can instantly become comrades during a moment of truce. Sanity and madness coexist at every hand. In a convoluted world, regarding war or mental illness, simple categories and clichés no longer serve us well.

SEARCHING FOR COMMUNITY (modified version of "Reel Life" column in Clinical Psychiatry News, July, 2004)

For years I lived a block from a community residential group home for adults with developmental disabilities, people who typically had spent years in institutions beforehand. Some stayed at home all day, others worked at sheltered industries. I waited for the morning bus with two residents, both with Down Syndrome, who crossed town to work at Goodwill Industries each day. The woman was shy: quiet and stable. The man was mercurial. Some days he was calm and friendly. On others he was angry, tearful, seemingly even delusional now and then. Sometimes I was able to “talk him down” as we waited. At other times, he remained so agitated he had to turn back alone toward home. Another man had cerebral palsy. At his best he was gregarious and inquisitive, drawn to visit if he saw me working in the yard. At his worst he was aggressive, and eventually he had to leave the home for assaulting others. What amazed me was the pluck these people showed, echoed by the perseverance of the staff. Surely conditions at the home were far superior to the grim realities of institutional warehousing, anomie, and passive vegetating I had seen on medical school “field trips” to state hospitals in the late 1950s.

Sueno House, in Santa Barbara, California, is such a residential home, the setting for a new film, Our House, a verite-style documentary directed by Sevan Matossian. Mr. Matossian is a staff member at Sueno House. Using digital video, he shot footage for this film over about a year, following the stories of three of the residents. We have more fleeting contact with others, notably Scott, a gentle fellow who worships one of the principals, Tim Staab. Tim S. (two of the principals are named Tim) has Down’s and is an obsessive cigarette smoker. He has stolen cigarettes from stores and written bad checks to get them. For these misdeeds he is on probation and court ordered to live at Sueno House. He also has a devilish sense of humor, loves to tease, and can escalate quickly from benign pranks to aggression, which has landed him in state hospitals in the past. His situation clinically is the least complex of the three principals.

Laura Langston, on the other hand, carries diagnoses of Fetal Alcohol, Tourette’s and Williams’ Syndromes, autism and OCD. She lived in a state mental hospital continuously from age 10 to 20. Abused physically and sexually as a child, she now vacillates between intense desires to be a woman or a man, to live in heaven or on earth, to live or to die. She has prolonged spells of shouting, jerking her arms and biting herself, and is drawn to religious rituals to find calm. She also melodramatically exaggerates and is manipulative. Tim Warriner - Tim W. – is, at 47, older by a decade or more than the others. Cerebral palsy left him wheelchair bound with mild spasticity of all four extremities and mild retardation. He has severe congenital malformations of both hands – he was born without thumbs - and had reconstructive surgery when young to reposition a finger to create an appositional thumb on one hand (the procedure failed on the other hand because of gangrene). Physically abused as a youngster, he witnessed his violent estranged father shot to death by his stepfather. He also is alcohol dependent and when drinking will not accept any responsibility for his frequent angry outbursts and related misconduct, invariably blaming others.

Staff are mostly young college age adults, like the staff at the group home on my own street. They are calm, respectful, very clear and unambiguous in their communications, and remarkably longsuffering in their efforts to aid the residents to get along as best they can. We watch the three principals struggling over the months to manage interpersonal conflicts and their own ambivalent impulses. We see the staff, in response, constantly attempting to strike a balance between honoring the rights – the civil liberties – of the residents (and letting them suffer the consequences when they screw up) versus setting limits for their safety and improved harmony for others. We suffer through Tim W.’s worsening bouts of drinking and eventual eviction. We ride Laura’s emotional roller coaster, including a possible overdose of chemicals and a four-hour Tourette’s rant. We follow Tim. S. through a crisis when he refuses to stop pestering Scott, and police are called to take him away, face a court hearing, and spend a weekend in jail, his first such experience.

This film gives us a slice of the life lived by the residents and staff: it’s the real deal. Still, life at Our House, like anyplace, is not without sweet moments of tenderness and humor. Scott’s simple, patient devotion to Tim S., despite the latter’s sometimes merciless teasing, is touching. One day a long harangue ensues between the two Tims over who is dumber. Each acknowledges without chagrin that he suffers from retardation. The question is, who’s worse off, and thus entitled to bragging rights about it. It’s difficult to convey here how genuinely funny the scene is, and when a staff member confronts them about what they are doing, it’s clear that both Tims are able to see the humor of it too.

The film is not without problems. Some viewers have raised an ethical question about the making of this film: did Matossian and his colleagues exploit their charges? I think there are hints of this in the filming of at least one person, Laura. Matossian, behind the camera, often asks questions of the residents as he films their responses. In Laura’s case, I thought he asked some provocative questions (already knowing the answers) in order to evoke emotionally charged responses from her that would demonstrate her faulty self control. For me, this did cross an ethical line a few times. At the end of the film, on printed stills, we learn of events concerning all three principals in the subsequent year after filming. The course of each is remarkably positive. We are informed that Tim W. has been abstinent from alcohol for 8 months in his new, more strictly controlled group home, that Laura is having fewer tic attacks, that Tim S. is succeeding at a new job in the community. It would have been more potent to demonstrate these improvements through brief follow up interviews.

What stays with me after viewing this film is the same sense I had about folks at the group home down my block. I’m struck by the courage and perseverance of the residents - their steadfast desires to be good people and live well - and of the staff who try to aid them. Sueno House is named for the street it’s located on, but it’s well to recall that this Spanish word means dream. The people who live at Sueno House, like all of us, dream dreams of a better, more satisfactory life ahead. It’s a difficult path they walk toward fulfilling those dreams. (For more information visit the film's website: www.ourhousethemovie.com.)

Dramatically compelling documentaries like Our House about people with developmental disabilities are uncommon. Perhaps the finest ever made was Ira Wohl’s 1979 feature length film, Best Boy. It is an engrossing story of the late but successful emancipation of Wohl’s 52 year old mentally retarded cousin, Phillip (“Philly”), lovingly filmed over three years by Wohl. Philly had lived with his parents all his life, except for a brief interlude at age 12, when he was institutionalized after suicidal behavior. The family were so shocked by the poor care he received that they took him home again. In the mid-1970s, observing that Philly’s mother, Pearl, and father, Max, were declining, and that Philly seemed capable of more independence than the doting Pearl permitted, Wohl set out with the dual purposes of influencing the family to let Philly spend more time out in the larger community, while at the same time filming what Wohl hoped would be Philly’s success in achieving greater independence. Philly did succeed. But along the way Max died. And only 8 months after Philly took a room in a community residential program for developmentally disabled adults, Pearl died as well, a terribly bittersweet ending. This powerful film deals leisurely and thoroughly with its subject.

More recently (in 2002), Alice Elliott made The Collector of Bedford Street, a short (35 minute) Oscar-nominated documentary about Larry Selman, a developmentally disabled 59 year old man living alone in Greenwich Village. After paying rent, utilities and other basics, Larry sometimes has only $10 left from his monthly social security disability pension. Yet he devotes his life to soliciting donations for others, like AIDS relief. He collects $3,000 - $4,000 a year for these causes, taking not a penny for himself. He also takes in stray cats and dogs, and the occasional homeless person. This latter activity has brought him into considerable conflict with his neighbors, for some of the people Larry hosts prove to be thieves. One caused a flood by plugging up a running sink. Larry was threatened with eviction. He has also depended for many years on the almost daily assistance of his Uncle Murray, who prepares Larry’s meals and does his laundry. But Murray is now 81 and must call up Larry to find out what day it is. In an astonishing act of community, Larry’s neighbors, most of them quite affluent, have collaborated to create a trust to assure that Larry’s needs will be provided for in the future. This is a splendid story of open-hearted reciprocity, between a very generous and special man and those who care about him. Larry is far more independent than Philly. One can’t help wondering, though, whether the differences could be a function of the differing approaches taken by the families in challenging their sons' capacities for independence.

The area around Olympia, Washington, south of Seattle, has become a hotbed of experimental filmmaking lately. Two films in particular merit attention because they address the perennial human quest for well-being. What the #$*! Do We Know!? ( What the “Bleep” Do We Know!? ) was created by William Arntz, Betsy Chasse and Mark Vicente. It’s a very busy inspirational film based on the premise that everything in the universe is mutable and uncertain, and, this being the case, there are always grounds for hope that things can change.

People in a score of western cities have been piling into theaters for months to see this film, some returning again and again; it’s a huge word-of-mouth success in these parts. And why not. We all need renewed hope, especially in troubled times. The film is an example of an increasingly popular film genre some call “narrative” or “essay” documentary, a filmmaking strategy in which a particular theme is approached from different angles, using different methods – here mixing an array of talking heads, computer animated sequences, and segments of a dramatized story.

Nearly a score of physicists, biologists, health professionals, and spiritual commentators press in upon us, earnestly explaining the connections between deep science and everyday experience. These talking heads chatter at newsbite speed to tell us how quantum physics proves that the world we call “real” is in fact just a series of possibilities. This being the case, we are told, our convictions about psychological reality, our presumed limitations, our assumptions about other people, are also just a few among many possibilities. Acceptance of a victim role and addictive devotion to pet beliefs make no sense. In fact our repetitive negative thoughts and feelings actually affect the microanatomy of our brains, creating a self-perpetuating, ever more ingrained set of expectations and behaviors. But we can choose to pursue other possibilities.

The drama concerns Amanda (played by Marlee Matlin, Oscar winner for her role in Children of a Lesser God), who in the years since a failed marriage has been burdened by persistent negative habits of thought, resulting in poor self regard, caustic appraisals of men, unhappiness and isolation. Spurred on by what can only be called cheesy bits of magical realism, Amanda begins to behave in uncharacteristic ways, and gradually her most cherished if cynical assumptions are challenged.

The animated parts are the best thing in the film. There are wonderful views of a labyrinthine jungle of neurons making up the brain, increasing and altering the connections among themselves in ever changing dynamisms as a result of experience. And there are lovable Disneyesque portrayals of chemical neurotransmitters, little anthropomorphic globules of red dopamine hotheads and blue, green and other cooler types prancing from site to site inside our heads. These parts are a lot of fun.

Thirty years ago, physicist Fritjof Capra wrote of the connections between quantum physics and consciousness in his underground best seller, The Tao of Physics. There’s nothing in this film that Capra didn’t cover as well or better way back then. Nothing new has developed on this theme in the intervening decades, and for good reason. The comparison of issues of matter and energy in quantum physics with human experience is an example of the perils of (false) reasoning based on analogy. The main connection between quantum physics and the study of consciousness is that a number of quantum physicists find themselves attracted to mysticism: the main links are the scientists themselves.

It’s quite enough to embrace the idea that experience does alter brain chemistry and anatomy. There’s no doubt of that. This is the biological basis of the observable fact that ingrained patterns of behavior, thought, emotional response, and addiction are so devilishly hard to alter. It is also true that when we risk new behaviors, when we combat the nearly irresistible tendency to repeat response patterns that are familiar, even if destructive, this can lead to positive changes, even, as the film suggests, changes in brain anatomy.

Quantum physics need not be invoked to explain or fortify these notions. To do so may bring the respectability of “hard science” to humanistic issues, but the price of this gloss may be to confuse many people, especially in the dizzying sort of presentation given in this film. (My partner, who is neither a scientist nor a mental health professional, found the film edifying but, curiously, she tuned out the physicists.) I did enjoy the more down to earth comments of Candace Pert, the molecular biologist who discovered the opioid brain receptor for endorphins, and several of the health professionals. But I was repelled by J. Z. Knight, who “channels” the spiritual entity “Ramtha.” Knight is a woman who endlessly blathers stagy mystical banalities but is just slick enough that she could probably sell oil to a Saudi. (The filmmakers are devotees of the Ramtha School of Enlightenment, which helped finance the making of this film.)

An ad promoting the film Group reads: “8 women; 21 sessions; 6 cameras; a therapist; and you.” To my knowledge, this is the first and only feature length drama that attempts to portray the process of group psychotherapy, in this case a time-limited, closed group for women seeking personal growth. Created by Marilyn Freeman and Anne de Marcken, Group is an ambitious effort rendered in mock-doc, cinema verité style, at the boundary between fiction and fact.

Drawing initially upon their own therapy experiences and the advice of a professional group therapist, the filmmakers prepared a tight script for group sessions. An overly constrained pilot session led them to jettison the script in favor of a more improvisational approach in which actors could be free to create dialogue and emotional responses within broad outlines of their assigned characters. Each actor prepared for her role over several months, meeting individually with the filmmakers. Everyone came together only when the shoot started.

De Marcken employed six dig-vid cameras - shooting simultaneously from various angles, natural light, no sound overdubs, and no retakes. The resulting footage is displayed in a mosaic of six small images, after the fashion employed by Mike Figgis in Time Code. All 21 one-hour sessions, which in the narrative occur once weekly over five months, were in fact shot over a single 10 day period. The final cut runs 106 minutes. The therapist is the real thing, a masters-prepared group psychotherapist and trainer with substantial experience (she is given a fictitious name in the film credits).

The result of all this effort is a powerful if sometimes disorienting experience. The use of six simultaneous images strikingly conveys the complexity of group therapy. Much of the time the participants seem like real people. All that coaching paid dividends. Compacting 21 sessions down to a 10 day shoot no doubt also ratcheted up the emotional intensity. A few cast members say in interviews that they found ways to draw upon their own emotional makeup and experiences; probably most did. The therapist is in several respects quite wonderful: she is the perfect model of poise, forbearance, patience, withholding of judgment, and genuine, kindly support.

Most of the women are young. Some seem therapy wise. The often traumatized Pipi (Nomy Lamm) appears to suffer from an incendiary Cluster B personality disorder, with narcissistic and borderline features. Rita (Lola Rock ‘N Rolla) is a sassy yet empathic biker chick with a heavy hint of antisociality. Grace (Carrie Brownstein), labeled as a “hypochondriac,” is a classically repressed woman burdened by an oedipal conflict; her symptoms began after her father took up with a girl younger than Grace. Claire (Kari Fillipi), whether schizoid or simply avoidant, is so painfully shy that she never speaks, except to whisper to the therapist who always sits next to her. The other players do not present well-defined clinical problems, as might often be the case in a self-selected personal growth group.

The filmmakers' intended purpose in employing 6 cameras - to permit the viewer to choose whom to watch at any given moment, and thus be more involved as if participating in the group - is highly compromised. One camera was always perched on a balcony above the group, providing tiny useless images of everyone at once. Often two or three of the other images show the same group member from differing angles. So in fact the viewer's choice of whom to watch is usually restricted to just two or three of the nine participants.

Segments featuring a single group member outside the group, intended to give background information, were intercut between group sessions. It would have better to use this time to have each member introduce herself during the first group session (background, current problems, goals for participating). The therapist should have discussed the "ground rules" for the group up front (acceptable conduct during sessions; confidentiality; seeking extra 1:1 sessions; socializing between sessions).

Too many of the characters verge on being stereotypes. Violet (Vicki Hollenberg), the lone middle aged woman, is too easily set up as the bigot, someone too “square” to reach across the generation gap. Clansey (Tony Wilkerson) likewise is typecast as a born-again Christian. As in any group, certain members, like narcissistic Pipi, monopolize the discussion, while others, like shy Claire, say virtually nothing. The therapist seems unusually passive in the face of these divergent styles, failing to facilitate more equitable sharing among the group.

This film provided an intense reminder for me of why I have never liked therapy groups - either as a leader or participant. I always found the process far too complicated to keep track of, and feel that groups are too easily influenced by the members who are the most verbally aggressive, controlling, charismatic or seductive. Despite its flaws, Group stands as a unique work, an instructive and sometimes revealing film about the nature of group therapy, and it is pretty good theater as well. (For more information on this film, visit the film website:
www.groupthemovie.com.)

For the past two years the Psychiatry Department at the University of British Columbia and an art/repertory theater in downtown Vancouver, Pacific Cinematheque, have presented “Frames of Mind,” a monthly evening film series featuring movies with psychiatric themes and post-film discussions led by mental health professionals and academics. The series has successfully brought together mental health and lay communities for dialogues about mental illness and care, according to its director, Dr. Harry Karlinsky, a psychiatrist who also directs CME activities and professional development for the Department at UBC.

Last January, “Frames of Mind” received an award from the Canadian Psychiatric Association as the most outstanding CME program in the nation. In May, Dr. Karlinsky directed the first Frames of Mind Mental Health Film Festival – a four day event screening seven feature length films, old and new (including “Sybil,” “Elling” and “People Say I’m Crazy”), short films, discussions with directors, screenwriters and mental health professionals, and workshops for youth and adults.

I happened to be visiting Vancouver in July when “Frames” was screening Samuel Fuller’s 1963 classic black-and-white drama, “Shock Corridor,” which I had wanted to see for some time. To some critics, it is the best “B” movie ever made, denouncing America’s bigotry, xenophobia and the arms race well before such critiques became common. Dr. Karlinsky kindly arranged for my partner and me to attend the screening as his guests. Around 90 people were present, nearly filling the intimate, comfortable venue on Howe Street, on a warm, sunny Thursday evening. The film was introduced by Ramon Kubicek, a writer, artist and film historian, who reminded us that Fuller’s films have always been appreciated more in Europe than here. (His iconic status abroad was acknowledged when he was cast in cameo acting roles by Godard, in “Pierrot le fou,” and later by Wim Wenders, in “The American Friend.”)

The film’s protagonist is Johnny Barrett (Peter Breck), an ambitious reporter who dreams of winning a Pulitzer prize by cracking the unsolved murder of a patient at a local public mental hospital. To accomplish this, he trains for a year to simulate psychosis, coached by a psychiatrist hired by Barrett’s editor. His exotic dancer girlfriend (Constance Towers) reluctantly agrees to pretend she is Barrett’s sister and complain to the police that he has an insane obsession to seduce her. This prompts a psychiatric examination where Barrett goes bananas, assuring his commitment to the hospital. Once inside, he gradually gains the confidence of three patients who had witnessed the murder. Along the way he is given medications and even endures electroshock therapy. Eventually he is able to expose the murderer (not one of the patients). But in the process, which takes months, Barrett experiences progressive unfeigned symptoms. In the most arresting scenes, he hallucinates a rainy deluge that floods the ward corridor and sweeps him helplessly along like a raging river. By the end he has become catatonic and inaccessible.

In their book, “Psychiatry and the Cinema,” Glen and Krin Gabbard refer to films like “Shock Corridor” as a subgenre of prison movies: lurid tales of involuntary institutions as tyrannical, punitive, inhumane places. Fuller’s hospital is a rough and tumble place, alright, where ECT is used as punishment, as it is in Milos Forman’s fictional drama, “One Flew Over the Cuckoo’s Nest,” made a dozen years later. In my view, placing such films under the umbrella of prison exposes tends to obscure the fact that many public mental hospitals really were wretched places where mistreatment of the mentally ill was commonplace. This becomes clearer when such films are compared not with prison films but with those set in private psychiatric hospitals of the era, like “David and Lisa”, “I Never Promised You a Rose Garden,” or “Girl, Interrupted.” Harsher than any fictional account was the real thing, depicted by Frederick Wiseman in his documentary, “Titicut Follies,” about conditions in a Massachusetts hospital for the criminally insane, that debuted four years after “Shock Corridor.” (“Titicut Follies” was also shown at the recent “Frames of Mind” festival.)

Fuller’s film is also a political movie, following a theme popular at the time: that insanity is a logical response to the pressures of an insane world. Each of the three witnesses to the murder became psychotic after enduring stresses related to important socio-political issues of the 1950s and early 60s. One had been a POW in the Korean War, brainwashed to speak out against the U.S.; returning home he couldn’t bear the guilt of this experience and now takes refuge in a fantasy world as a Confederate Civil War officer. Another had been the first African American admitted to a southern university; but he wound up on the ward an arch bigot, delusionally convinced he is white, inciting other inmates against the occasional black patient. The third was a scientist who had helped develop nuclear weapons and rockets for the space race, but he now acts as if he were an innocent young child, making simple drawings and playing kid games.

Lest you think that this film is all grinding grimness or irony, I should mention that there are amusing interludes as well, though the humor does play on ill informed notions about the mentally ill. At one point Barrett sneaks from one room into another, and finds himself surrounded by a phalanx of alarmingly feral women. “Oh, Oh…Nymphos!” he mutters, just before they attack him. He has a porcine roommate who sings opera and teaches Johnny a sure fire non-pharmaceutical treatment for insomnia: just stuff an entire pack of chewing gum into your mouth, chew until all your jaw muscles are thoroughly fatigued, and this brings on sleep.

How hard is it to simulate mental illness and gain access to treatment? Easy as pie. At least back when this film was made. It didn’t take a year’s training or intricate responses, contrary to Fuller’s script. Stanford psychologist David Rosenhan showed this in his notorious study, “On Being Sane in Insane Places,” published in “Science” in 1973. Rosenhan and seven other “stooges” merely presented themselves for admission to various public hospitals with the complaint that for three weeks they had heard a single voice that simply said “thud.” They were all admitted.

Once inside, per plan, the subjects behaved normally and said the voice had stopped. Aside from giving false names and not disclosing that they were research plants, they gave accurate personal histories to interviewers. They were kept on the wards an average of 19 days, often medicated (they were trained to cheek meds), and their diagnosis (always schizophrenia) was never questioned by staff. Actual patients, on the other hand, often figured out they were fakes.

Another psychologist, Lauren Slater, claims she has replicated Rosenhan’s study more recently, after improvements in the DSM, with a similar outcome, except that this time outpatient drug treatment for depression was the typical response. This suggests to me the important role of fashion-of-the-times in psychiatric diagnosis, treatment and treatment setting.

Are people who fake mental illness for external gain vulnerable to actually developing such illnesses? There have been anecdotal reports from time to time to this effect, suggesting that the choice of fabricated symptoms is determined by the patient’s unconscious vulnerabilities. Modern systematic studies do not support this notion, however.

Surely there is something psychologically deviant about malingering. Not everyone does it, after all. Among those who do, there is at least a high likelihood of antisocial or histrionic personality disorder, and the presence of such a disorder does place a person at greater risk for faulty coping responses and consequent symptoms under stress. As for the form that trumped up symptoms take, the source of inspiration these days is more likely to be a checklist gleaned from USA Today, Oprah or the DSM-IV than the patient’s own imaginings.

After the screening, Peter Breck himself turned up for a Q & A moderated by Mr. Kubicek. Breck, robust at 75, lives in British Columbia these days, and is still involved in acting, filmmaking and teaching. After some regional theater success, he was discovered by Robert Mitchum and cast in his first (uncredited) Hollywood role in the 1958 Mitchum film, “Thunder Road.” He was a regular on TV’s “Maverick” and “The Big Valley” series, and thereafter had many more TV appearances over the years.

In “Shock Corridor,” Breck is dragged about the ward in ways that might bang up anybody, but he takes pride that he performed this and much of the stunt work in other films himself (“as long as I started and ended up on the ground,” he says), while insisting that stuntmen be paid when assigned to his films, even if he did the stunts himself. For this generosity he was voted into the stuntmen’s guild.

He recalled for us the experience of working with Fuller, a notoriously independent man who produced, wrote and directed all his films to maintain total control. When initially interviewing Breck for “Shock Corridor,” Fuller gazed intensely at him and suddenly exclaimed, “Your Johnny Barrett, Yes Sir! I see it in your eyes! You’re sick!” The role was Breck’s. Fuller urged Breck to use in his acting whatever impulse came to him as a scene unfolded: “If you think it, do it!” Fuller told him. Rather than the prosaic “lights, action, camera” introduction to a scene, Fuller would instead ask calmly if everyone were ready, then, after a silent pause, abruptly shoot off a pistol blast (presumably a blank). Breck claims that this was highly effective, banishing all prior thoughts as everyone turned their undivided attention to the scene.

Breck also recalled Fuller’s reassurance about the flooded ward corridor scene: Fuller told him that if the water got too bad, he could always exit the hallway through any of the doors. Trouble is, Breck told us, when he tried this during the scene he found the doors were all nailed shut. Shock corridor indeed.

French director Patrice Leconte is fascinated by offbeat, ambiguous relationships. Most of all, he likes to film quirky love stories. “ Monsieur Hire” (1989) concerns a forlorn voyeur obsessed by a beautiful young woman. “The Hairdresser’s Husband” (1990) is about an eccentric drifter whose lifelong passion for women barbers is finally fulfilled. In “The Girl on the Bridge” (1999), a down and out carnival knife thrower and a striking young woman save each other from suicide. And in “Felix and Lola” (2001), another carnie with dubious prospects is attracted to an untrustworthy seductress. Even in “The Widow of St. Pierre” (2000), although the story focuses to a degree on the connections between two men, their tie owes its weight to the more substantive relationship each has with the same enigmatic woman.

In all these stories the men are middle aged, shopworn by responsibilities, neurosis or hard living. The women are attractive, mysterious and bold. More bold than the men, who tend toward reticence and inhibition. The women also seem more influential, if not stronger. A sexual relationship isn’t essential (as in “M. Hire” or “Felix and Lola”), as if this is less important than the man’s fascination with the enigma of the woman, and her ability to evoke hidden aspects buried within him.

Now we come to Leconte’s latest love story, “Intimate Strangers” (in French with English subtitles). The script, by Jerome Tonnerre, reprises all the familiar Leconte themes. The film even stars Sandrine Bonnaire, who played the young woman that M. Hire had his eye on in Leconte’s film 15 years earlier. Here she is Anna, a dyslectic, depressed Parisian beauty seeking help for marital troubles. Her husband Marc (Gilbert Melki) has become emotionally and sexually estranged. On the day of her first appointment with a psychoanalyst, she gets the directions to his office wrong - turning right instead of left as she exits the lift - and mistakenly ends up spilling out her problems to an upscale accountant, William Faber (Fabrice Luchini). Faber is fiftyish, fastidious and plain. He is so retiring and spellbound by this lovely woman, whom he first mistook for a new tax client, that he cannot collect himself enough to stop and redirect Anna. When she asks for a second appointment, William reflexively consents. He tries to square things at the second meeting, but Anna dismisses his claim not to be a doctor by saying she is aware that not all analysts hold doctorates.

Anna fails to keep a third scheduled appointment, and this eats at William. He goes down the hall to the office of the analyst, Dr. Monnier (Michel Duchaussoy), hoping to learn Anna’s phone number, and ends up recounting his predicament to the analyst. Monnier – older, wry, wise, cocksure - tells William that the whole business is no doubt over, then demands a stiff fee. But it isn’t over. A few days later, Anna barges into William’s office unannounced, furiously declares she has discovered the truth, says she feels raped, and storms out. Later that night she returns (his office and living quarters are connected), apologizes, and asks to keep seeing him, to continue to use him as a therapist. Hopelessly hooked, William agrees.

Things get dicier when Marc comes around, accuses William of having an affair with Anna, and then says it’s alright, provided that William and Anna conduct their lovemaking in the couple’s home, with Marc’s full knowledge. Instead, Marc’s fantasy of the affair seems to revive his own sexual appetite for Anna. Marc even arranges for Anna and himself to make love in a hotel room across the way from William’s quarters, telephoning William and instructing him to watch them through the windows. At their next session Anna is aglow, but this vanishes when William tells her of Marc’s little scheme. Anna breaks off the sessions. Months pass. William grows restive. He decides to close his offices and move to the south of France. He finds Anna again. She’s left Marc and is teaching ballet. They each delight in their reunion. The final scenes suggest that romance may be in the air.

Leconte’s favorite love themes are abundantly evident here. There’s his familiar formula for a relationship: a reticient, middle aged man is captivated by a beautiful, mysterious woman. William is portrayed as immature. He still lives in the apartment where he was raised; he carries on a business inherited from his father that also includes old Mrs. Mulon (Helene Surgere), who was Dad’s secretary. William gives pride of place in the office to his windup toy collection. He has never married. When Anna begins to discuss her sex life, William seems undone and rushes off for another consultation with Dr. Monnier, who observes that a woman’s disclosure of her secret sources of pleasure is always a scary business for men. “It reminds them of when they were little boys,” he says.

William is in thrall to Anna, his countenance always a perfect blend of astonishment and adoration. Anna tells him that she sees a tightly locked room in the back of his psyche. She’s right, though William’s is probably not an extreme case of Oedipally inspired repression. He has had, after all, at least one lengthy affair: we meet his former lover Jeanne (Anne Brochet); they still find time for an occasional quickie. When Anna first tells William that Marc is urging her to have an affair, William’s titillation is evident. That evening we see him dancing alone in front of a mirror to Wilson Pickett’s “The Midnight Hour.” He’s terrific: uninhibited, strong, balanced, nimble, stylish… everything he is not in daily life. William is helpful to Anna. He listens well. He offers sound advice: that she should consider leaving Marc because of his callous treatment of her; that she should find a way to reconnect with ballet, for dance had been her passion years earlier.

Reviewing Leconte’s romance films, one can detect positive movement over time. Love ended badly when one party died in the earliest of these films (“ Monsieur Hire,” “Hairdresser’s Husband”), and came perilously close to ending similarly in “Girl on the Bridge.” But that couple and their love survived. “Felix and Lola” seems an aberration in this arc, an uncharacteristically poor film, for Leconte, in which neither romance nor its failure carried much emotional charge or consequence. “Intimate Strangers” is the most upbeat of these stories, an account in which both the man and the woman are able to overcome their neurotic self entrapments, each helping the other in the process, at least to the degree that at the end they reencounter one other on a more promising footing than before. Is Leconte becoming more optimistic, less gloomy, about love’s prospects?

There’s a fair measure of humor in this movie, amusing moments provided in particular by Dr. Monnier and the ever present Mrs. Mulon, who monitors each moment Anna and William are together in the office. Despite hints to the contrary, this is not a suspense thriller. Granted, some of the music is suspenseful. And there is a slightly crazed air surrounding the jealous Marc. But nothing beyond these bits suggests any Hitchcockian movements afoot. If anything, Marc’s extreme behavior serves only to set up reference to a well worn old saw about love. When William at one point tells Marc, “You’re sick,” Marc replies, “Love is an incurable illness.”

Speaking of illness, does this film imply that anybody can treat anybody else? Dr. Monnier reassures William that it may help for him to keep seeing Anna. “She found an open ear,” Monnier says. “Even barbers and bartenders don’t listen anymore.” He’s not trivializing analysis here. He’s musing about the universal human need for someone to listen to our stories. Most life crises are resolved informally, after all, when an aggrieved person turns to someone else, like a trusted friend, for aid. It doesn’t take an analyst.

For that matter, few would disagree that any intense relationship potentially can open the way to deeper change and self-awareness. Jerome Frank, in his classic work, “Persuasion and Healing” (3 rd edition, J.D. and J.B. Frank, Johns Hopkins University Press, Baltimore, 1993), demonstrated that simple human offerings of interest, trust, hope and respect are powerful change agents. Both parties may be altered by a deep relationship, including psychotherapy. Professional training helps shield a therapist from blind or reckless change, and other blunders, by examining countertransference reactions and invoking some theoretical framework for understanding (and usefully distancing oneself from) the patient. For better or worse, William lacks these protective strategies.

All of that said, it is curious that we end up knowing a lot more about William than about Anna. She still seems enigmatic to the end. Nevertheless, William in the final scene moves closer to Anna, seemingly intent upon lifting the veil of mystery from her, as if he no longer requires the defense of puzzlement, of unknowing, to fortify his repression.

There are one or two sideswipes at psychoanalysis here, and a few tired clichés: the gratuitous Victorian fainting couch in William’s office; Jeanne teasing William that he has developed the analyst’s knack for saying, “Mmmmmm”; the analyst’s keen attention to getting paid. One day Anna helps an agoraphobic patient of Dr. Monnier’s overcome his avoidance of the lift, and lightly suggests that now he may no longer need treatment. On the other hand, Dr. Monnier is awarded most of the memorable lines in the script. “The tax accountant and the analyst. We both treat the same neuroses: what to declare and what to hide,” he says. On another occasion, over a lunch he gets William to pay for, Monnier coaches William, “It’s the patient’s job to lead the hunt. The analyst knows nothing.” Again, this isn’t professional self-deprecation. He’s simply stating a cardinal rule of all good clinical interviewing: to learn the truth, let the patient speak and keep your own biases to yourself.

This film gives psychoanalysis a good natured poke, not a serious knock. You could even imagine this as a fable written by an analyst, a voluptuous fantasy of having your patient and helping her too, while getting all the good lines, the fees, immunity from ethics charges, and a free lunch into the bargain.

Murray Bowen, the pioneer family therapist, often defied convention by purposely preventing couples in conflict from talking to each other during sessions. He would engage one partner in a long dialogue while the other silently observed. Bowen thought this could provide an opportunity for the observing partner to witness the other in a better light. Over time negative perceptions of each partner can build up, displacing more positive ones. The engaged partner in therapy might put a better foot forward talking with someone outside this domestic loop of negativity. The observing partner might then be able to glimpse positive attributes of their loved one, maybe even features that had been so attractive in the first place, when the couple first met.

I thought of Bowen’s ideas while watching “Eternal Sunshine of the Spotless Mind,” Michel Gondry’s romantic suspense story of the dire steps taken to end a relationship when a couple’s discouragement with each other looms large, after the infatuated gloss of perfection wears off and the warts begin to show. Dire steps indeed. As everyone interested in movies must know by now, the young woman, Clementine (Kate Winslet), having determined to break off an affair, avails herself of a new high tech brain altering treatment: the selective electronic removal of all memories of her former lover, Joel (Jim Carrey). Joel accidentally discovers what she has done, and in furious retaliation he undergoes the same treatment.

The film opens just after both Clementine and Joel have had their memories of one another erased. They meet (again) on the same beach where they had first met, two years earlier, suggesting that some nuances of memory of their former shared experiences remain, however inchoate these may be. Clem and Joel don’t recognize each other, but they are mutually attracted, just as they had been originally.

Following this introduction, we briefly move backward a few days to witness Joel’s discovery of Clem’s memory erasure and his impulsive arrangements for his own procedure; then forward again to the evening he is scheduled to have his memories erased. Next we learn all about Joel and Clem during the hour long middle segment that is the centerpiece of this film, its breathtakingly inventive core, as Joel’s selective memory removal procedure takes place, in his apartment, over the course of a long night, while he lies in drug aided slumber, wearing an outsized helmet adorned with circuitry.

Theirs has been a case of opposites attracting. Clem is animated by a breezy impulsivity and forwardness. Her hair color varies from blue to red to tangerine. Her bohemian apartment is a clutter of plants, yard sale furniture and tchotzkes. She’s a superficially ditzy yet soulful woman who just wants the basics in life: a loving partner and family. Joel on the other hand is shy, self-effacing, cautious. He finds in Clem a catalyst to release his own spirit and have some fun. Joel is steady and reliable, a perfect foil for Clem’s capriciousness.

Problems can arise, of course, when opposites attract. Choosing someone with complementary characteristics, needing another to feel whole or balanced, is more risky than a match of people with much in common. As the months go by, traits that were once endearing become the focus of increasing acrimony. Responsible, sober Joel becomes jealous, dull, wet blanket Joel. Carefree Clem is now frivolous, irresponsible and, Joel suspects (in error), unfaithful. Joel’s suspicions and his refusal to consider having a baby prove to be deal breakers.

Carrey, in a role nearly devoid of his patented hyperbolic physical comedy, is entirely convincing as the understated, almost melancholic Joel. (His physical talents are put to good use in brief flashes during the memory erasure sequence.) Winslet invests Clem with such insouciance and spontaneity that one forgets this is acting. Credit Mr. Gondry for superb direction of his leading actors. The cast is rounded out by Tom Wilkinson as the kindly Dr. Mierzwiak, inventor of the memory erasure process, and his staff at Lacuna, Inc: assistants Stan (Mark Ruffalo playing against type as a techie nerd) and Patrick (an even nerdier Elijah Wood), and receptionist Mary (a blandly sincere Kirsten Dunst).

Joel’s nocturnal memory removal session is marked by a kaleidoscopic review of key moments in the couple’s relationship, scenes presented in reverse, from recent events back to their first meeting two years earlier. These scenes – electronic evocations of Joel’s specific memories, preprogrammed during an earlier office visit by the good folks at Lacuna – do double duty. They acquaint us with the couple’s history and are also the memories that are targeted for removal, one by one, as they come up. Nice narrative economy.

All goes well until about halfway through the night, when Joel summons enough awareness to realize he’s in the midst of the erasure and wants it stopped. He conveys this to Clem in newly imagined scenes, conflations of Joel’s memories with fresh narrative detail and direction composed by Joel in the moment, during the procedure. In these imaginings, Clem and Joel devise a plan for both of them to “hide” - to become fugitives from the erasure process - by attempting to invade memories stored elsewhere in Joel’s brain, childhood memories that are beyond the purview of the erasure program. In search of cover, Joel and Clem race desperately along just ahead of the erasing process that deletes people or objects a mere step or two behind them.

Meanwhile, dereliction and ethical anarchy have broken out in Joel’s apartment among the Lacuna staff supposedly monitoring the erasure process. Stan and Patrick get drunk. Patrick talks loudly of his infatuation with Clem since helping with her erasure and finally leaves to meet her. Mary drops over and gets stoned with Stan as they lie in bed next to the comatose Joel. Then they dance, eat, drink and generally whoop it up. All this commotion seems unnecessarily over the top, the film’s one sizable flaw. But it does serve the purpose of stimulating Joel’s level of arousal and his efforts to resist the erasure; he never fully awakens, but he does hear some of what’s said by these people. Dr. Mierzwiak is finally called in to successfully “find” the couple and conclude the procedure.

Unlike screenwriter Charlie Kaufman’s last script, for Spike Jonze’s “Adaptation,” where an inane ending betrayed a rich story, “Sunshine” ends very well indeed, its formidable loose ends pulled together believably, without compromising the fatalistic overtones of the story or ditching the classic romantic formula in which boy eventually must get girl. A disaffected Mary, who finds her own reasons for believing that Dr. M’s work is wrong, mails patient files back to them, including taped interviews. Clem and Joel (now back at the film’s starting point, after they have met for the second time) receive theirs and listen in dismay as each describes the process of disenchantment with the other. Yet even armed with this foreknowledge of inevitable future frustrations, they pledge to try again.

Kaufman relishes invading somebody else’s head in outrageous ways. People literally entered a famous actor’s brain in Kaufman’s story for Jonze’s earlier film, “Being John Malkovich.” Kaufman’s conceit here - the memory eradication procedure – is, of course, equally preposterous. It requires major brain damage for a person to lose the capacity to identify previously important people. Wiping out old memories (retrograde amnesia) cannot occur without even more profound damage to the capacity for forming new memories (anterograde amnesia). That is the protagonist Leonard’s plight in Christopher Nolan’s highly praised film, “Memento.” After a closed head injury, Leonard cannot recall crucial events before the blow, but, much worse, he has altogether lost the capacity to create memories of new experiences and information, and thus he must constantly make notes and snap Polaroid photos to compensate. The most common cause of a person losing the ability to identify a loved one is Alzheimer’s dementia. Only in psychogenic amnesias are memories for the past “lost” without impairment of new memory formation.

That said, it’s easy enough to suspend disbelief about Dr. Mierzwiak’s methods. Biotechnology has, after all, recently brought us PET scans and functional MRIs that can show little parts of the brain being activated or deactivated when people are depressed or crave cocaine. What’s more, we are pulled in emotionally by the fresh, tender, humorous and compelling texture of Clem and Joel’s love and the fury and pain that follow their falling out. Who doesn’t know of the desire of an aggrieved lover to “get the other person out of their mind” when the relationship fails? Kaufman’s ploy is a brilliantly concrete realization of that anguished universal romantic yearning for relief.

Joel’s mental experiences on the night of his erasure seem much more like dreams than memories. Critic Stanley Kauffmann, writing in “The New Republic,” calls this the most convincing attempt to portray a dream sequence that he knows of on film. Indeed. We witness elements of symbolic condensation, wish fulfillment, incorporation of contemporaneous environmental cues into the imagined narrative, and intentional introduction of novel motives and actions into these imaginings, as occurs in “lucid dreaming,” where the dreamer directs the dream. Associational links occur between Joel’s humiliation at one point by Clem and a time in boyhood when his mother discovered him masturbating. Dr. M. tells Joel (in another reverie), “I’m not the doctor, I’m part of you,” just what any Gestalt therapist would say about dream characters.

A magical collaboration has occurred here among Gondry, Kaufman, cinematographer Ellen Kuras, and editor Valdis Oskarsdottir, resulting in the invention of dazzling scenes and film structure. The memory removal conceit serves the love story so well that, in the end, it doesn’t matter that it’s neuroscience fiction. It’s been such a great visual trip, and emotionally it feels right. That’s all we need. This film wondrously infuses a lively romantic comedy with adventure, wisdom and heart.

ALL THAT GLITTERS: BRINGING BACK METALLICA (modified version of "Reel Life" column in Clinical Psychiatry News, December , 2004)

In 2001, the legendary heavy metal rock band Metallica had reached the nadir of their 20-year association. No recent albums or tours. Heck, they were barely able to speak to one another. Their managers, worried that a major cash cow was going mad, brought in Phil Towle, a self proclaimed “performance enhancement coach,” to shore up relations among the band members. A new album and tour were envisioned. And filmmakers Joe Berlinger and Bruce Sinofsky (who had made the provocative crime documentaries, “Brother’s Keeper” and “Paradise Lost: The Child Murders at Robin Hood Hills”) were hired to make a promotional film covering the recording sessions and tour.

Before group sessions with Towle could even begin, however, long time bass player Jason Newsted quit the band. (Metallica producer Bob Rock, a journeyman bassist himself, was tapped to fill in for the album.) The film gradually morphed into a documentary, the recently released “Metallica: Some Kind of Monster,” a rare fly-on-the-wall chronicle that is part psychodrama, part musical odyssey, following the band for two years as the players struggle to create new songs while living through a period of acrimony and doubts about their future. It’s long (135 minutes), but the film succeeds in showing how tough a craft pop music making can be, for a group seeking to rediscover itself.

It is clear from the getgo that the two original organizers, lead vocalist James Hetfield and drummer Lars Ulrich, are both heavyweight personalities with world class alpha male egos. And neither is a happy camper. They grumble and glower. They are also both approaching 40, with wives and houses and little kids to care about. Life isn’t just about the band anymore. Lead guitarist Kirk Hammett is a different sort, an outwardly relaxed, go along, get along fellow who, mercifully, never adds to the tensions, though he does chirp once or twice that he wishes his own ideas were listened to by the others now and then. Bob Rock stays in the background.

Not long into this project, Hetfield abruptly enters a three-month residential alcoholism rehab program that stretches out to a year. The filmmakers use this limbo period to advantage, filling in the band’s history and profiling its members’ current lives. There’s a particularly absorbing segment when Ulrich’s father Torben comes to visit. A skinny, gnomish guy, with long gray hair and beard, Torben – who’s been a painter, tennis pro, jazz musician and journalist – pronounces unsparing judgments on some of the new album tracks. You can see where Lars gets his self-assertiveness.

When Hetfield returns, he immediately tries to take charge once again, insisting on four-hour workdays and forbidding the others to make decisions about the music or even review tracks in his absence. This is way over the top for Ulrich, who makes his finest speech in angry protest at a group meeting with Towle, telling Hetfield that he tries to control everyone in every way, even by his absences. This seems to be a turning point. Hetfield backs off. Things get less bumpy; he and Ulrich begin to find consensus about the songs. Near the end, the album wraps, a new permanent bass player (Robert Trujillo) is chosen and in the final scenes we see the start of the new tour. The group’s cohesion and synergy appear to be restored, perhaps even enhanced by the newcomer, Trujillo, a wildly energetic yet gentle showman.

So who’s Phil Towle? We see a lot of him in the film. He seems to be more or less encamped with the band, present during rehearsals and recording sessions as well as in round-the-table, therapy style group discussions. He’s about 65, slightly built, typically dressed in geezer sweaters and slacks. Nearly always he comports himself in a quiet, unassuming manner. Much of the time he says nothing, and when he does speak, his comments are brief and simple, employing common tactics for facilitating discussion. There’s little evidence of anything flashy, no psycho-judo or New Age mumbo, in his technique. Once he does get on a kick about creating a “zone” for positive work in the studio. He writes out little signs and plasters them everywhere. It’s hard to follow but appears to be an effort to influence the ambience by defining a space where everyone will enter with positive expectancies. In any event, the game backfires when band members refuse to enter “the zone.”

I searched in vain on the Internet for any professional reference to Towle. Nada: no bio or resume. In film reviews he has been called a psychiatrist, a sports psychologist, a doctor and a PhD. In fact he is none of these. (The following information about his professional record is contained in an article, “Your Life Need a Tune-Up?” by Gina Piccalo, that appeared in the Los Angeles Times, April 21, 2004.) Towle earned a bachelors degree in sociology, worked in settlement houses in Chicago, and later took a fellowship in psychiatric social work at the Menninger Clinic in Topeka.

He conducted a private psychotherapy practice for many years in Kansas City but switched to working with professional football players and coaches, pop musicians and corporate CEOs in the mid-1990s. According to Ms. Piccalo, who interviewed him, Towle was defensive when she asked about his professional background, claiming it is not relevant to his current work. He told Piccalo that he grew tired of working with “people’s nightmares,” longing instead to “work with their dreams.” He says a performance coach dwells on people’s strengths and positive attributes, not their weaknesses.

In the film, Metallica band members credit Towle with helping them significantly to resolve their conflicts and renew the band’s focus and musical integrity, though how he helped is not made clear. Possibly his simple presence as an expectant fair witness was useful. Then again, how much should the band’s turnaround be credited to Hetfield’s personal rehab program, or the time out it imposed on the band? Or to increasing pressure from the band’s managers that we see occurring? The others also feel that Towle was beginning to overstep boundaries, hanging around the studio too much, even offering song lyrics. Ulrich teases him one day, saying that next Towle will want to play drums. Band members learn that he is considering a permanent move from the midwest to the San Francisco bay area, where the band makes its collective home. They wonder if he envisions a permanent affiliation with them.

When they share with Towle that perhaps his work should end, or at least wind down, this provokes the most prolonged and animated verbal display Towle musters in the film. In fact he becomes highly defensive, asserts that the work is not done, that he has visions of fulfillment for the band, and each individual in it, that are far from being realized. He suggests that the group is being distrustful. He’s really riled up.

Turns out this isn’t the first time he’s reacted badly to clients’ efforts to terminate work with him. Ms. Piccalo writes, and I quote here from her article, “Ten years ago, one of Towle's psychotherapy clients filed a complaint with the Kansas Behavioral Sciences Regulatory Board, accusing him of urging her to continue therapy after she decided to end it. The board investigated and, among other alleged violations, cited Towle for ‘continuing treatment when it was not beneficial to the client’ and ‘failing to terminate the social work relationship.’ Ultimately, Towle admitted no liability or wrongdoing, but he agreed to dissolve his practice and surrender his license,” according to Piccalo. “Today,” she goes on, “he declines to talk about the case but acknowledges he's experiencing ‘an ongoing process of healing and growth. It is still hard for me to let go of whatever's unresolved, because when you see it and you know something can be done about it, it's hard to look away.’ “

Lack of licensure in any of the psychotherapy dispensing professions is no doubt an additional reason that Towle insists that his present work is not therapy but performance enhancement coaching, an activity that presumably is beyond the purview of licensure. Performance enhancement through verbal facilitation is far from being a new phenomenon. The use of psychologically-oriented discussion groups (called “T-Groups”) to increase the effectiveness of business leaders was pioneered in the late 1940s at the National Training Laboratories in Bethel, Maine. California psychologist Bruce Ogilvie is credited with founding the discipline of sports psychology in the mid-1960s, to help athletes perform better. A cursory Internet browse reveals that psychological methods are in vogue around the world to aid musical performers.

As for glitter, another motive for Towle to preserve his ties to Metallica could be the $40,000 monthly retainer he was receiving. Even at $300 an hour, that’s 133 hours a month, more than 30 hours a week. Towle told Ms. Piccalo that he was on call 24/7, and that the band is just one of his 15 active clients. The numbers boggle the mind. Maybe it isn’t fair to measure Towle’s fee based on hours spent. Finances are highly inflated in the world of big entertainment. Millions of dollars would be lost if Metallica imploded. One website promoting performance enhancement coaching for executives talks of fees in terms of return on investment. An ROI of 6:1 to 10:1 is considered pretty good.

The new album (“St. Anger”), Metallica’s first in five years, went platinum and won a Grammy award. The newly reconfigured band was feted on an MTV “Icons” special. The international tour last year was a success. If these results generate profits of at least $6 to $10 million, probably a modest estimate, then a million or so for Towle might not be unreasonable by an ROI standard. (In fact, gross revenues for a 2004 domestic tour topped $60 million). I’m not sure what he’s paid these days, but Towle did move to the bay area and continues to have contact with the band.

TOO CLOSE FOR COMFORT (modified version of "Reel Life" column in Clinical Psychiatry News, January , 2005)

“Closer,” a new film directed by Mike Nichols, is an inquiry into the darker side of love. It deals with sexual obsession, possessiveness, intrusiveness, distrust, jealousy and betrayal. In particular it is about the tenuous balance that exists, at best, between the conflicting human needs of intimacy and privacy. To be known or not to be known, that is the question. In love the boundaries that separate two persons and serve to contain their individual personalities - their “selves” - give way compellingly to the urge to merge, for two people to become one. At what point does merging threaten or dishonor the integrity of the individual? What are the proper limits of closeness? This story asks such questions.

The setting is contemporary West End London. Natalie Portman is Alice/Jane, a young American who earns her way stripping or table dancing; Jude Law is Daniel, a failed novelist who write obits for a daily newspaper; Julia Roberts is Anna, a professional portrait photographer, and Clive Owen is Larry, a dermatologist who has just started up a Harley Street private practice.

I think of Julia Roberts as principally a romantic comedienne, and a darn good one at that. In “Closer,” she gives the finest serious dramatic performance I have seen her do. Her face in closeup reflects so much depth of feeling, mainly in the wistful, pensive, subtly melancholic registers, as befits the character she inhabits. Natalie Portman here is a dazzling force of nature; it’s her second stellar turn in a row, following her fine contribution as Zach Braff's quirky love interest in “ Garden State.”

Jude Law plays ably against type: not the suave, sensuous glam man, but a blundering, insensitive neurotic. Clive Owen is much coarser here than he was as Jack Manfred in “ Croupier.” This brilliant, versatile foursome are deftly directed by Mr. Nichols and are a joy to watch. They remind me of another fine ensemble in Ken Russell’s 1969 film of D.H. Lawrence’s “Women in Love,” which featured Alan Bates, Oliver Reed, Glenda Jackson and Jennie Linden, exploring somewhat similar issues.

The musical score consists mainly of selections from Mozart's "Cosi Fan Tutte" juxtaposed with bossa nova numbers, among other pop material. For the most part the music blends so unobtrusively with the proceedings on screen that one is unaware of the score: nearly always a good sign. But at a few key moments, just the opposite occurs. The most striking example is when Daniel and Anna first touch in her studio. The score at this point, a gentle passage from “Cosi,” seems almost to embrace the couple, to enfold them within its sweet strains. The effect is wondrous.

The film opens in the past, though we don’t yet know that, when Daniel witnesses Alice, a stranger on a busy street, struck down by a taxi (she was looking left instead of right, a risky error that newcomers to Britain sometimes learn the hard way). She’s only scraped up a bit. They get acquainted when he takes her to the ER, and they end up living together.

Perhaps two years go by, and we next see Daniel having his photo taken for the jacket of his first novel. He’s smitten with the photographer, Anna, who requites his feelings. A few nights later, Daniel amuses himself by pretending to be a woman visiting an Internet sex chat room where he’s linked up with Larry, who’s passing time while on call at a hospital. Daniel, presenting himself on line as Anna (he describes her looks), agrees to meet Larry next day at the aquarium. By coincidence, Anna is visiting the aquarium and Larry approaches her. They begin an affair that rapidly leads to marriage, but even before they marry, Anna also begins an affair with Daniel, which she continues after marrying Larry.

All this goes on for a year, at which point Daniel and Anna tell their respective partners about their affair and break off with them in order to be together. The abandoned partners are separately miserable. They meet once by chance ( or is it?): Larry wanders into a flesh club where Alice is dancing. They may (or may not) have a brief sexual tryst. Eventually Anna and Larry reconcile. Dan and Alice also get back together, but only briefly. Dan presses Alice unceasingly to divulge whether she had sex with Larry, and, when she finally says she did, to share all the details. Alice responds to these demands for intimate details by telling Dan she suddenly no longer loves him, it’s the end. She means it.

Despite the length of Anna’s affair with Daniel, Larry, though hurt, is forgiving – he wants Anna back. Nevertheless, he behaves toward her in the same obsessively jealous, competitive, intrusive manner as Dan has treated Alice. Larry wants to know all the details of Anna’s lovemaking with Dan, even which locations in their house they used for sex. “Why, why, why must you do this to me?” Anna asks Larry. But in the long run she too seems forgiving; her love does not appear to be mortally damaged by Larry’s bullying probes, unlike Alice’s loss of love for Dan.

The story is bold in declaring the differences between men and women in love, especially when in comes to sex. Both men are obsessed with issues of sexual performance and response. Neither can tolerate not knowing exactly what went on sexually between their beloved woman and the other man. Neither man has any regard for the woman’s right to privacy.

It’s as if we haven’t moved an inch from the primitive notion that women are the sexual property of men. Like buying a used car and demanding to know all the details about past ownership and servicing records. Or the provenance of a painting.

And men obsessively measure their sexual conduct in comparative terms. “Was he a better fuck than me? “ they demand to know. Women do not understand this male bent and are deeply (and understandably) offended by the interrogatory invasion of their personal space and memories. Men’s insistent, hectoring inquires can be experienced as a forced entry. Sociobiologists will, of course, be more forgiving, pointing out that these men are simply doing their job in attempting to perpetuate the species by retrieving information to fine tune their future sexual performance.

The differences between the two men, and between the women, are equally intriguing, though they are etched less distinctively in the screenplay. You might say that Larry had the greater grounds for sexual jealousy. He was cuckolded for a year and then jilted by Anna. His interrogations of Anna are not excusable because of this, but they are understandable. In contrast, it was Dan who rejected Alice and then got squirrelly over a single sexual encounter she may have had with Larry. Dan speaks of his own selfishness, and he’s clearly less mature than Larry.

Late in the story, Larry tells Dan that he doesn’t understand compromise, while Larry and Anna do. When Dan further reveals his naivete, his superficiality, by saying that everyone is simply looking for happiness, Larry challenges that notion. He says that may not be true of Anna, that she’s a depressive sort who may find confirmation for her negative outlook on life in a relationship that is not so full of happiness.

True or not, Anna tolerates Larry’s intrusive questioning; it doesn’t extinguish her love. Alice, on the other hand, is younger, more innocent, more in love with an ideal of love, and thus more delicate, her love more fragile. Dan’s invasion of her privacy is a deal breaker for Alice. Dan, who had seemed the gentler of the two men, in fact has seriously miscalculated the fragility of Alice’s feelings and mishandles her. The force of his intrusions shatters her ideal, and for her that’s the end of love, snuffed out in an instant. Quick as a person with a borderline personality can switch from idealizing another to hatred and rejection. (Alice indeed may have a borderline personality, though I think that is beside the point.)

Memories of past relationships constitute essential building blocks of personality. Harry Stack Sullivan said that personal identity, one’s very sense of self, is the sum of all the reflected appraisals one receives from the important people in one’s life. We are shaped fundamentally by relationships, by how others regard and treat us. Forcible intrusion into these private realms does violence not only to the integrity of cherished memories, but to the very fiber of the individual. In intimacy, one must expect to encounter mystery in the other, and let that be.

Good as the ideas and acting are, this film feels throughout more like a theatric production than a cinematic one. Dialogue, while full of meaning, is often formal, quick and too smartly accomplished, unlike the sloppier syntax and more uneven pace of ordinary conversation among intimates. There’s lots of talk and not much action. “Closer” is virtually opposite to another recent film about failing love and infidelity among two couples who are close friends, John Curran’s “We Don’t Live Here Anymore.” That distressingly realistic film is long on action, and the conversation is plain and ordinary, though devoid of discernable insights or ideas.

The formalism of “Closer” is unsurprising, since the screenplay is an adaptation of a stage production of the same title and was written by the playwright, Patrick Marber. His theatric production in London received the Olivier/BBC and London Critics Circle awards for best new play of 1997, and it has been performed in over 100 cities since then. (Clive Owen played the role of Daniel, not Larry, in the London stage production.)

For me, despite its flawed cinematic values, “Closer” is entirely effective in exploring the question of finding the right distance in love: not being as close as possible, but being close enough.

THE 'COMEDY OF NEUROSIS' AFTER WOODY (modified version of "Reel Life" column in Clinical Psychiatry News, February , 2005)

Recently a good friend who doesn’t see many films was lamenting the decline of Woody Allen, saying that no one’s making intelligent comedies anymore. Hey, Woody could still make a comeback, I said, but what about Alexander Payne? Or Charlie Kaufman’s collaborations with Spike Jonze and Michel Gondry? Or Zach Braff? My friend looked puzzled. Granted, smart comedies - based on wit and well etched character foibles - are never in abundant supply, but 2004 gave us several doozies and inspired hope that more will follow.

Besides Gondry and Kaufman’s “Eternal Sunshine of the Spotless Mind,” reviewed in this column three months ago, I can offer two other prime examples. “Sideways,” is Payne’s latest hit, a highly amusing guyflick about two old college roomies, now nearing 40, with a romantic subplot thrown in. Miles Raymond (Paul Giamatti) is your basic restive, dysphoric Everyman. He’s dumpy, lonely and has a serious drinking problem. He teaches 8 th grade English in a San Diego middle school, and has spent years rewriting a sprawling novel that his agent cannot get a nibble for.

Miles has been in therapy for two years since his wife divorced him. He regularly uses Xanax, Lexapro and a major quantities of wine (it’s never made clear that such a combination is hazardous). From the perspective of his best friend Jack (Thomas Haden Church), none of this has helped. What will help, Jack sincerely believes, is for Miles to get laid this week.

The occasion is a trip the two have planned, driving up into the wine country of northern Santa Barbara county, to celebrate Jack’s impending wedding the day after they return. The itinerary calls for golf, plenty of good food, and sipping some fine varietals. (Miles is a consummate wine nerd: he knows his structures and can detect the hint of asparagus in a cab as well as the strawberry and pepper.) Oh, yes, and getting laid is on the agenda, well, on Jack’s agenda at least: it’s his last fling. Miles could care less.

Jack, I should add, is about as opposite to Miles as can be; he’s a huge hunk of a fellow, a TV actor who’s on the early downslope of his career, formerly a regular in a couple of TV series, nowadays doing some commercials and voiceovers. He’s not the brightest bulb on the tree, but he’s cheerful, sensitive and devoted to Miles. And he’s perniciously horny.

Before long Jack has arranged a double date (mum’s the word about Jack’s imminent matrimonial plans). Miles is matched with Maya (Virginia Madsen), a recently divorced restaurant server he’s visited with on earlier trips to the wine country, and Jack himself is paired with Stephanie (Canadian actress Sandra Oh), a wine pourer who shares Jack’s carnal appetites. They are soon swept away in a rush of frenzied lovemaking, while Miles and Maya talk earnestly about wines. Maya asks at one point why pinot noir is his favorite, and when Miles rhapsodizes about the delicacy of the fruit, its sensitivity and thin skin, its need for constant nurturance, we all know that Miles is talking about himself, not just grapes.

After a couple of days in the hay, Jack goes off the deep end, starts fantasizing about a different life, settling down with Stephanie and her little daughter. Miles rages at him, calls him (quite rightly) an infant, reminds him about his fiancée and the wedding a few days hence. Jack, for his part, is furious with Miles: for drinking too much, forever pouting and glowering, and hanging back from Maya, who obviously likes him.

These two guys are each as canny in their insights about one another as they are blind to their own foibles. For good reason. They typify the two faces of narcissism. Jack is full of himself, vain, self indulgent, in constant need of female adoration, a guzzler of life. Miles is self critical, finicky, isolative, pessimistic, a timid sniffer and sipper of life. He may be self denying, but he’s also self absorbed, writing a 7 inch manuscript that’s mainly about him.

Things veer out of control later in the week. Miles manages to rise above his negativity long enough to have some intimate moments with Maya. But inevitably the secret of Jack’s wedding comes to light, and Stephanie beats the bejesus out of him with her motorcycle helmet. Maya also feels deceived by this news and refuses further contact with Miles. The guys head back to San Diego, sadder for sure, but wiser? Who knows? Jack’s wedding takes place as planned. Miles returns to teaching. But then one day he gets a letter from Maya. In the final scene he comes knocking at her door up north. The picture fades to black.

Everything about this film is well crafted, sure, a pure pleasure to watch. Payne’s direction here is impeccable, and the screenplay, adapted by Payne and longtime cowriter JimTaylor from Rex Pickett’s novel, is briskly paced. Photography by James Glennon, music by Rolfe Kent, and production design, with unsparing attention to myriad small details, by Jane Ann Stewart are equally impressive efforts. Payne and his filmmaking team have worked together for about 10 years now, not unlike the long term collaborations Allen arranged. (Payne’s earlier films – all good - include “Citizen Ruth,” “Election” and “About Schmidt.”)

Mr. Giamatti’s character is much like that of his Harvey Pekar in “American Splendor.” Will we be seeing more of this Giamatti persona? Is a rough cut, Italian version of Allen’s neurotic antihero emerging here? Not a citified hot house flower (he grew up in New Haven, not New York City), Giamatti’s (ig)noble nerd has more spine. Where Allen whined when angry, Giamatti gets his dander up. On the golf course one day with Jack, Miles is incensed when someone in the foursome behind them hits a ball close to where he’s standing. He snarls, yells, tees up and fires a shot right back up the hill at the other group. Just what Chaplin or Tati might have done.

“Garden State,” created by Zach Braff, is fresh, tender, quirky, genuine: the adjectives just pour forth to describe this deliciously funny coming-of-age movie, with a subtext of romance. First time writer-director Braff also stars as Andrew, a 25 year old marginally employed actor in LA who returns home to New Jersey for his mother’s funeral. He hasn’t been around his old friends or seen much of his father since he was sent off to boarding school at 16. Several disparate forces move Andrew now to rethink his life.

The first, of course, is his mother’s death. We never meet her but learn that she had been rendered paraplegic years earlier, when she fell in the kitchen, after being pushed by an angry 9 year old Andrew. Plagued by poorly controlled emotions after that (what kid wouldn’t be?), Andrew was placed on medications to blunt his moods by his psychiatrist father (Ian Holm, in a minor role), and had remained emotionally numbed by meds for the past 15 years. He was dispatched to boarding school for the same reason, to decompress the emotional angst in the family household. Amazingly, we are informed of Andrew’s past without resort to a single flashback.

Dissatisfied with the course of his career and life in LA, Andrew decides to stop taking his mood stabilizing medication upon learning of his mother’s death (there’s no aside to the audience that abrupt discontinuation of psychoactive meds can produce distressing withdrawal). Back in the suburb where he grew up, reunions with old chums now contribute to Andrew’s unfolding self reappraisal. More importantly, he meets Samantha – Sam (Natalie Portman), an inquisitive young woman who seems to care about and accept him from the get-go.

In the end it is the budding romance with Sam that catalyzes Andrew’s resolve to change his life. But Andrew could not have responded to Sam had he not first freed himself of the enormous burden of guilt for causing his mother’s paralysis, a burden only made worse by his father’s misguided “treatment” of Andrew’s non-existent mood disorder and his virtual banishment from the family. He confronts his father about these matters in one of the film’s more moving scenes.

Among several reasons why this film works so well, perhaps the most important is the lack of schmaltz. There is not a single note of melodrama or pathos here. No shouting or screaming. We are never insulted by belaboring of the obvious psychological nuances in play. Braff writes with respect for the intelligence of his audience. Many little scenes and plot twists delight because they are unexpected gifts. The off key pop solo sung by Andrew’s aunt at Mother’s funeral. Various people living in odd circumstances. One old buddy got rich selling his invention of soundless Velcro and now scoots down the corridors of his unfurnished McMansion in an electric golf cart. Another buddy, Mark (Peter Sarsgaard), sells jewelry he acquires in a highly unusual manner.

Braff also writes simple yet refreshing dialogue, with plenty of offbeat humor, yet none of it is strained, nothing is played self-consciously for laughs. Braff himself has a warm, easy-to-watch screen presence. He can say nothing during the lull in a conversation, while the camera remains focused on his face, and it feels right. Portman and Sarsgaard are also genuine, each wonderfully relaxed in their roles.

This film never seems to manipulate us; instead it engages, stirs curiosity and amusement, bids us gently to care about Andrew and Sam and even Mark, leaving us entertained in the best sense. This movie is as confident, as secure in itself, as comforting, as a well worn pair of house slippers or your favorite reading chair.

VETS AND THE VA: ANOTHER KIND OF WAR STORY (modified version of "Reel Life" column in Clinical Psychiatry News, March , 2005)

Article 99, a 1992 film directed by Howard Deutch, has renewed relevance now. It is a unique, ambitious effort to portray problems in the Veterans Affairs (VA) Healthcare System, problems receiving greater attention recently because of the unanticipated high numbers of wounded combatants returning from Afghanistan and Iraq. This month marks the second anniversary of our invasion of Iraq, a fitting moment to revisit this film, which tells a story based on the indisputable scarcity of resources to take proper care of Veterans, and how this plays out in one particular urban VA hospital.

Limited capacity is a fact of life in the hospital, and a major subtext of the film concerns the lengths to which doctors on the surgery staff go to assure that patients get what they need (the surgeons are played by Forest Whitaker, John C. McGinley, Lea Thompson, chief surgeon Ray Liotta and new intern Kiefer Sutherland). Examples include “turfing” patients - shuttling them from ward to ward, even assigning trumped up diagnoses to justify transfers, as a means of providing continuity of care rather than forced discharges - and bootlegging necessary but administratively forbidden surgical procedures.

Another subtext is the huge bureaucracy, long lines, brusque clerical staff, endless paperwork and Catch-22 regulations that drive VA patients and their doctors batty. “Shooter” Polaski (Leo Burmester), a menacing hulk who suffers from combat-related PTSD, gets a letter from the VA declaring him eligible for “…full and complete medical benefits. However, as your diagnosed condition cannot be specifically related to military service, treatment is not available at this time.”

"Article 99" is cited as the authorizing regulation for this notice. Shooter’s response is to rev up his pickup and crash into the lobby of the hospital and down a corridor until it finally collides with something bigger. This gets Shooter exactly what he wanted in the first place, namely, care on the psych. unit, where he is treated by a staff psychiatrist (Kathy Baker) who left a better paying job to care for Vets.

A plot twist concerns the clandestine pirating of resources away from patient care to fund a costly new surgical research program, a pet project of the unscrupulous hospital director (John Mahoney). When the surgery staff discover this scam, war breaks out between them and the director, a battle that culminates in a huge demonstration and media feeding frenzy in front of the hospital, orchestrated by a powerful patient leader, Luther (Keith David), a hip, wheelchair bound, cell phone wielding fellow who wears sunglasses round the clock and is always tricked out in medals commemorating his past military exploits. On demonstration day, he’s also got an AK47 in hand. Of course, Luther and the good guys prevail. It’s that kind of movie.

I worked intermittently in one capacity or another in three different VA facilities between 1959 and 2002, including 15 years as Chief of Psychiatry at a teaching and research oriented (“academic”) VA hospital affiliated with a nearby medical school, so I have a good vantage point from which to judge this movie. Though many details are exaggerated and farcical, following in the tradition of Robert Altman’s MASH and its more successful TV series sequel, M*A*S*H, there is a crucial core of truth to this story.

Fact is, there has never been sufficient funding from Congress to assure uniformly high quality health care across the vast nationwide VA system of 170 facilities. In a franchise like McDonald’s, you get pretty much the same menu everywhere. Not so in the VA. Despite recent efforts to achieve budget parity using complicated mathematical models, there still are “have” VAs and “have nots.” The richer ones get that way because of the political clout of Congressional representatives, affiliated medical schools and Veterans organizations on behalf of that particular hospital.

Although VA bureaucratic regulations are staggering in their complexity, self contradictions and ever changing fine print, there is no “Article 99” - that’s a fiction invented for this movie. In fact it is a non sequitur. The only way a Vet can receive guaranteed “full and complete medical benefits” is if a VA disability rating board first finds this person to be suffering from one or more service-connected disabilities, i.e., some condition that was caused by, began or worsened during, active military duty.

Moreover, the aggregate degree of disability from all service-connected conditions combined must be at least 50% in order for a Vet to get comprehensive health care benefits, which means care not only for service-connected problems but all other health care needed, as in an HMO or Kaiser. (Lesser extent of disability – under 50% - restricts guaranteed care to that specifically needed for the rated disability, not other health problems.)

Often vets who are convinced that their health problems were caused by exposure to combat, toxic agents or other hazards, when they were in military service, make claims for service-connection to the VA that are denied. Sometimes these denials are entirely justified. False attribution of disability to military duty usually occurs through a patient’s honest but poorly informed beliefs, less often through a consciously fraudulent attempt to gain benefits.

But it is also true that the VA, like many private corporations, has a sordid track record of stonewalling and denial of connections between disabilities and military duty in order to save money and whitewash government responsibility. In the 1980s, I was able to show that among the four independent VA disability rating boards operating just in my geographic area, the proportion of claims for combat-related PTSD that was approved varied from less than 10% by one rating board to nearly 50% by another! The reason for such discrepancies was subjective bias (acceptance or rejection of the idea that combat could be blamed for long lasting psychiatric symptoms) among members of these quasi-judicial review panels.

If a Vet does not have a service connected disability, whether he or she can get health care at a VA facility depends on factors such as how well funded that particular hospital is, what kind of care is needed, whether the Vet has other health insurance, whether copayments required in some cases are affordable, and the Vet’s income level.

A currently operative 2003 executive order from the Bush Administration has halted enrollment of most middle income veterans, even those without health insurance, according to a Harvard Medical School study released last October. The same report noted a 14% increase in the number of Vets without any health insurance between 2000 and 2003. Many Vets are refused care or placed on long wait lists, and this makes people very angry.

You might think Shooter’s outrageous pickup drive through the hospital is implausible, but at my VA, we once had an angry psychiatric outpatient who tried a Kamikaze dive of a small airplane into our psych unit. Miraculously, he crashed in a garden just in front of the building, harming no one but himself. On another occasion, one of our psychologists was summoned to the top of a high utility tower elsewhere in the city to “talk down” a desperate Vet needing care. Pretty dramatic stuff. Events of this sort happened in the early years of our program, when funding was minimal. Later, in an era of greater staff resources and treatment options, such events ceased.

Luther, by the way, is also the real deal: there’s a Luther or two at every VA. I think of them as “career patients,” eccentric, often charismatic men whose lives seem to have peaked during their years in the military, and who now derive their primary identity and self esteem from the colorful positions they create for themselves in the VA hospital milieu.

The scam to rip off patient care resources for research also rings true, sad to say. Shenanigans only a hair less larcenous have occurred in dozens of medical school-affiliated VA hospitals over the years. For many years I myself subsidized nationally prominent researchers using clinical budget funds. They gave our program prestige and gloss, locally and system-wide, helped attract high quality young recruits to our staff, and carried weight when it was time to compete with the other hospital departments for new clinical funding. In the long run, patient care was enhanced by this strategy. Spending money to make money. That’s the way the game was played in many research-oriented VAs. Recent reform efforts have reduced, but not eliminated, such tactics.

There’s one theme where a false note is struck in the film. Although there are many idealistic doctors in the VA who are dedicated to caring for Veterans, regrettably, in most VA hospitals with strong academic missions, some staff physicians tend to give only secondary priority to patient care. Sometimes senior physicians rotate from the medical school to supervise care on VA wards; they may have little sense of the VA’s specific mission to serve Veterans. Staff physicians and trainees alike may see their VA patients as “cases” providing opportunities for practicing “procedures.” On surgical services, bedside follow up care is often left to the least experienced doctors, the interns.

My main problem with this film has to do with its dramatic aims and structure. On the one hand, it strives to be a social exposé film, on the other, an over-the-top comedy. In trying to have it both ways, I think its impact in both directions is muted. It works better as social criticism. As for comedy, the film, like the VA itself, isn’t adequately staffed. Ray Liotta is no Alan Alda, and Kathy Baker is no Sally Kellerman. It’s left up to a few supporting players to shoulder the humor load here: John C. McGinley, Keith David and Leo Burmester. The little love subplots - Liotta and Baker, Sutherland and Thompson – add nothing to the proceedings. This film is a decent effort on an important subject, but it could have used more bite and more laughs.

TRAUMA AND TRANSFORMATION (modified version of "Reel Life" column in Clinical Psychiatry News, April , 2005)

Discussions of the lasting effects of trauma tend to emphasize the morbid psychological sequelae that may follow exposure to life threatening or otherwise catastrophic events that are beyond the pale of everyday experience. We refer to these consequences under the rubric of post-traumatic stress disorder (PTSD). There is also a rich though largely anecdotal literature about the seemingly positive aftereffects reported by some survivors following traumatic near death experiences. Two films in particular vividly depict these phenomena as well as the fragility of such positive states: Fearless (1993) and Regarding Henry (1991).

In Fearless, a film directed by Peter Weir, Jeff Bridges stars as Max Klein, a successful architect who is among the survivors of a commercial airliner crash in a cornfield near Bakersfield, California. Moments before the crash, as the airplane plummets, he experiences an epiphany: his life is ending, he realizes, and this produces within him not panic but a state of sudden serene acceptance.

Max turns to reassure panicky passengers nearby and then leaves his seat, next to his business partner, moving up to sit with a frightened young boy who is traveling alone. His partner is killed on impact, but Max, who’s uninjured, remains calm and leads several other passengers to safety before explosions erupt. In subsequent interviews survivors recall him as their savior.

Max’s dissociative state

This experience is transformative for Max. In the hours that follow, he feels removed from his life before the crash, distant from his family. He spends that night at a motel in L.A. and doesn’t even bother to call his wife, Laura (Isabella Rossellini), to tell her he is alive. FBI agents soon locate him and send him home. He chooses to fly, having no fear of the plane. Indeed, he now seems unfazed by stressors of any sort, sees no prospect of risk to himself in any circumstance: he feels invulnerable. He boldly crosses busy streets in mid-block. Even his life-threatening anaphylactic allergic response to strawberries seems to have disappeared: he can now gobble them down with relish.

Max disdains the maneuvers of a lawyer (Tom Hulce) to assure a sizable settlement for himself and for his dead partner’s family. He shows little interest in work and other routines. He’s short tempered with his son, emotionally isolated from Laura. Max now seems interested only in helping two of the other survivors: the young boy he had comforted before impact and a woman, Carla (Rosie Perez), whose infant was killed in the crash. He encounters Carla at a group trauma debriefing arranged by Dr. Perlman (John Turturro), a psychiatrist hired by the airline, who seems rather inept in his efforts to help these people, even though he claims expertise about PTSD.

Carla is especially hard to reach. She is mute, withdrawn, terribly depressed. Dr. Perlman arranges for Max to visit Carla. The couple end up walking into a church, and this marks the beginning of Carla opening up, over the course of many visits they share. Laura is understandably baffled and more than a little jealous about Max’s emotional estrangement from her and their son, while his evident preoccupation with Carla’s well being only seems to grow more intense with time.

Cracks in Max’s defensive armor

Matters come to a head when Max begins to exhibit more dangerous behaviors. In one incident, he drives a car into a brick wall with Carla in the rear seat holding a toolbox, to demonstrate to her how it was beyond her control to keep hold of her baby against the force of impact when the plane crashed. This demonstration works, and there is a breakthrough in her survivor guilt.

After this, however, more cracks begin to appear in Max’s serene façade. Laura discovers in his den a series of disturbing paintings he has made suggesting death (each consists of a violent, chaotic, abstract scape with a deep red vortex at its center). Max himself eventually seems to sense that he is on a dangerous path and asks Laura to “save” him.

The film ends when Max nonchalantly eats a strawberry and this time experiences one of his accustomed anaphylactic reactions, a bad one. In Laura’s arms and near death from asphyxia, he re-experiences moments from the time of the crash, when he is leading others from the plane. But now this memory is merged with an image of an intense white light at the end of the dark tunnel-like fuselage, and Max is seen walking slowly away, receding into the distance, toward the light.

We know that if Max survives this attack, he will once more be himself; no longer a man living a dissociated life, denying his vulnerability; beyond the beatific state he has floated in for weeks, in the world yet apart from it. And we know that while he will regain much that is valuable and true of him, should he survive, at the same time he may also lose something of great value, a quality of the spirit, a sublime, transcendent element that had sustained him through a dark and terrible time.

Portrayals of PTSD

I regard Fearless as one of the best feature films about PTSD, in a class with Ordinary People and The Sweet Hereafter. Rafael Yglesias, who adapted his own (then unpublished) novel for the screenplay, displays a keen understanding of clinical, psychodynamic and spiritual issues surrounding PTSD. Mr. Bridges is masterful as Max. His matter of fact portrayal is consistent with someone who has responded to overwhelming, life threatening stress through dissociation, splitting off his fears and encapsulating them in a virtually unconscious compartment, expressed only through his paintings and occasional, seemingly impulsive bouts of dangerous behavior. Otherwise he is serene, protected from his fears by denial, repression and isolation.

Max’s withdrawal from his family and life routines is an all too common phenomenon in PTSD, and a cause of much family and occupational dysfunction, in the majority of cases where a dissociative state is not part of the picture. Laura’s bewilderment is typical of the quandary spouses of trauma victims frequently experience. They feel shut out, and they are.

The only clinical element missing here is sleep disturbance: we should have seen some evidence of this in Max and Carla. Ms. Perez does a fine job of expressing survivor guilt and its associated emotions. The importance of a spiritual element also rings true. Frequently traditional, adjunctive interventions of the sorts employed by clergy (confession, witnessing, meditation, expiatory acts) provide therapeutic traction when conventional psychotherapy alone has failed.

A life-changing gunshot injury

Regarding Henry, directed by Mike Nichols, tells another story of positive post-traumatic consequences. This well made film features Harrison Ford in an impressive performance as Henry Turner, a highly successful but predatory, coldhearted, narcissistic New York City lawyer who one night dashes out to a convenience store for cigarettes, where he is shot by a thief, thereby changing his life.

One bullet penetrates the right frontal lobe of his brain, but this does little damage. Another bullet to the upper chest causes massive bleeding and hypoxemia (insufficient oxygen in the blood), resulting in widespread brain injury. Following a prolonged period in coma, Henry makes a steady if labored comeback. We see scenes of his therapy in a neuro-rehab center and get to know his wonderful physical therapist and all around role model and chum, Bradley (Bill Nunn in a splendid turn).

Henry has residual problems: left sided weakness, a patchy memory, some social awkwardness and a profound change in personality. He is now docile, openly affectionate, caring and compassionate. His ties to his wife and daughter are radically altered (for the better), but he cannot go back to his career – not so much because he’s now deficient in the skills to practice law but because, as he reviews files of his old cases, he is horrified by the unscrupulous tactics whereby he had won them..

Ford is marvelous: it’s one of the best performances of his I’ve ever seen. He steadily maintains his character’s handicaps and is in fact quite convincing in demonstrating his deficits and their gradual partial recovery. He consistently displays the same limping gait, partial paralysis of his left arm, sometimes fumbling speech, and social hesitancy. Mr. Nichols knows how to work so well with actors. Not only do Ford and Nunn excel, but also Annette Bening (as Henry’s wife) and Mikki Allen (their daughter).

Personality change after trauma

People can, of course, experience pervasive personality changes from widespread brain injury, but typically these take a form in which the new features of the patient’s temperament are apathy, explosive angry outbursts, manic or hypomanic moods, or facetious disinhibition. I’ve never known of anyone whose love of family or altruism were enhanced by brain injury.

On the other hand, some individuals do recover from traumatic near-death experiences with profound positive personality alterations, not because of any brain damage but because of the long lasting psychological and existential effects of survival and the near-death experience itself on their values and social behavior. Such people often speak in terms there being a new sense of purpose in living inspired by their experience.

More information on the phenomena depicted in both of these films can be found in several sourcebooks, including “The Near Death Experience: A Reader,” edited by Lee W. Bailey and Jenny Yates (New York, Routledge, 1996); “Lessons from the Light: What We Can Learn from the Near-Death Experience,” by Kenneth Ring (New York, Insight Books, 1998); and “The Complete Idiot’s Guide to Near-Death Experiences,” by P.M.H. Atwater and David H. Morgan (Indianapolis IN, Alpha Books, 2000).

ALL ABOUT MY MOTHER (modified version of "Reel Life" column in Clinical Psychiatry News, May , 2005)

Out of the Shadow and Tarnation are noteworthy documentaries in which filmmakers tell stories of their own mothers, each suffering from schizophrenia. These bold films share much common ground but differ radically in narrative style and aesthetics.

In both films we meet women who were once strikingly beautiful and full of promise, before their debilitating journeys through dark labyrinths of severe, persistent mental illness and dysfunctional public mental health systems. We grasp the hardships endured by the filmmakers when they were children being reared by psychotic mothers. We observe the steadfastness, compassion and burden of responsibility that mark the relationships between these adult children and their mothers today. Both films are honest and unencumbered by self pity, mawkishness or manipulation. Here the similarities end.

Out of the Shadow, directed by Susan Smiley, a veteran television documentarist, recounts the problems her mother Millie’s illness has posed - for herself as well as for Susan, her younger sister Tina, and others. The film is quite short ( 67 minutes), yet the important issues concerning the experience and consequences of schizophrenia are illuminated with clarity and authenticity in an unhurried manner. Old family photos and home movies are nicely intercut with recent scenes and interviews. Direct audio is supplemented by Susan Smiley’s narrative voiceovers. This is a skillful, straightforward documentary production, made with remarkable economy.

Millie’s Descent

Millie was 25 when she first showed signs of schizophrenia, shortly after Susan’s birth. Her erratic behavior led Susan’s father to divorce Millie, leaving her to care for Susan and Tina, ages 3 and 1 year. Millie often beat Susan, who was more defiant, while Tina shielded herself through ingratiation. After Susan left when she was 12 to live with her father and stepmother, Tina bore the brunt of Millie’s rages.

The girls wouldn’t tell anyone how bad things could get at home, fearful that their mother might actually kill them. And Millie had periods of ostensible normality. It was easy for the other adults to deny the extent of the problem for years, a situation that changed only after Tina made a suicide attempt, in early adolescence.

What ensued was a wretched 20 -year journey for Millie and her daughters, a course that is familiar to many families with a loved one suffering from severe chronic schizophrenia: 17 hospitalizations, 40 or more living places, no employment, frequent brief periods of homelessness, a serious suicide attempt, a cycle of ever changing mental health providers and constantly revised medication regimens.

Meanwhile, the girls grew up . Susan moved to Los Angeles to make films. Tina married and moved to another state . T heir efforts to keep track of their mother were often frustrated, not only by Millie’s erratic movements , but also by regulations that prohibited caregivers from sharing information about her whereabouts or condition without Millie’s written consent, something Millie refused. Millie received care within a system Susan accurately describes as “fractured.”

Susan’s restraint – her canny ability to avoid axe grinding harangues, instead simply showing us over and over again how the system fails to work – is remarkable. (Though Millie lives in Illinois, the “system” there functions about like that in any other state.)

W e don’t just see Millie as a patient, a collection of symptoms and social conundrums. Susan is careful to show us the brighter, more charming, “ normal” side of her mother, who is still capable on her good days of conveying the soft, endearing aspect of her personality. We do see how emotionally changeable, how mercurial, she can be.

Light at the End of the Tunnel

There is a happy ending, and it is not contrived. In fact it is a product of long hard work by Susan and Tina, and also some simple good luck. A guardianship is arranged, and Millie qualifies for placement in a group home, what Susan calls the “holy grail” of care in the Illinois system. It is a small place with skilled supervision and a guarantee against eviction. Millie regains stability there. After a few months she joins her ex-husband’s second family and her daughters for an enjoyable Christmas gathering. She begins her first job in 30 years, as a dishwasher in a nearby restaurant. Millie may still lack insight that she suffers from an illness , but she’s stable and proud of herself.

This film is a tour de force: a drama with a strong narrative arc, central characters who are all sympathetic, and a comprehensive, edifying look at the problems of chronic mental illness in this country. More importantly, Susan Smiley has managed simultaneously to grace her film with a sense of deep emotional involvement and also a scrupulously dispassionate, and therefore all the more powerful, gaze at the problems for everyone posed by her mother’s illness and the faulty public care system on which they all must depend.

An Odyssey of the Damned

Tarnation is the first film created by Jonathan Caouette (the title is an old term for “damnation” or “Hell”). This is a confessional, intensely personal film about Caouette’s hellish experience growing up in a deeply troubled family. We learn about him, his chronically psychotic mother, Renee, and his grandparents, whose early prosperity gave way in middle life to aimless, barely rational existence.

For present purposes, we must pass over important segments of the film that chronicle Jonathan’s own development and gradual emergence as a gay man. Suffice it to say that he managed to extricate himself from the family morass and his adolescent pattern of self-destructive behavior, moving from Texas to New York City in his mid-20s. There he found a gentle, dependable lover and a measure of stability, and these assets have given him the will to exercise an impressive artistic genius in creating this film.

Tarnation is made in a style that could hardly differ more from that of “Shadow.” It is a raw, sometimes lurid, often painful account, presented in a kaleidoscopic, fast paced, Warholian montage of scenes ingeniously crafted from family photos, old home movies and videos, commercial film and TV show clips, answering machine messages, video diary commentaries, computer generated split screen, mosaic and briefly flashed still imagery, an ever changing palette of colors and black and white, a broad array of music from traditional kids’ Sunday School ditties to punk rock, and more.

Rather than narrative voiceover, Caouette utilizes still text intercuts to fill in the storyline and aid transitions. These are brief, easy to read, not overdone. Caouette tells his story thematically, impressionistically, like an artist, with only a moderate nod to details and chronologic exactitude. Be warned that this can cause some viewer confusion.

Renee and Her Illness

From the film’s opening scene, when she sings “This Little Light of Mine,” to the last scene, in which Jonathan lays his head on her sleeping chest, Renee is cast as the central character in Caouette’s life. She maintains a vivid presence in our minds even during long stretches when she does not appear on screen.

Jonathan says her diagnosis is schizophrenia, but from her manicky conduct in the film I can’t be sure she isn’t bipolar. She probably suffers from that hybrid, schizoaffective disorder. (In contrast to “Shadow,” which cited a half dozen well known consultants, no professional psychiatric advisor is listed in this film’s credits.) Jonathan informs us that Renee has endured 100 psychiatric hospitalizations over a 35 year period, and first had electroconvulsive therapy (ECT) treatments at age 12 or 13. Before her illness, she was recognized regionally as a lovely teen model, and it is sad to see her features coarsen along with her behavior over the years. Today she is at large, somewhere in Texas, probably not in treatment, and far from finding a happy ending.

The Comfort of Causal Myths

Jonathan, Renee and her parents go to some length to externalize the possible cause of Renee’s disorder. Renee blames her parents for physically mistreating her as a child, but her stories of abuse may be fabricated. (She also doubts that they are her real parents, preferring to think that Elizabeth Taylor is her mother. Jonathan also tells us that Renee harbors a delusion that her entire family experience is part of a government experiment.)

Renee fell off a rooftop at age 12, and never seemed the same afterwards, leading to a family belief that brain injury caused her disorder. Jonathan asserts that there was nothing psychologically wrong with his mother before she was given numerous ECT treatments in adolescence, implying that unnecessary treatment damaged her, causing her mental illness.

Contrived external causes of course serve a purpose for distressed families whose loved ones are afflicted with severe mental disorders. They bring a measure of comfort, however meager. They assuage guilt and brush away worries about hereditary influences on others. Unfortunately false convictions of causality can also subvert effective treatment.

But we see here, in the film’s penultimate scene, what Jonathan must face when the myths are stripped away. It is 5 am and he has arisen early to make a video diary entry. He sequesters himself in the bathroom so as not to disturb the household. It is just a few weeks after Renee had taken a near fatal overdose of lithium, and he has brought her to New York to stay with him and his partner. After a long pause, he begins to cry softly and speaks of his fear that he will turn out like his mother.

SHRINK WRAP: THE BEST & WORST PSYCHIATRISTS ON FILM (Modified from an article published in "Canadian Psychiatry," August, 2005)

Given the fact that so many people in the film industry have sought the services of psychoanalysts and other psychotherapists over the past 60 years, it is surprising how few films offer good portrayals of our colleagues at work. When a psychiatrist or therapist is portrayed, all too often the role is used to embody a character with deep personal problems, thus pandering to a common public stereotype. Or the therapist is only briefly glimpsed, a shadowy figure, far from complete, a cameo used as the brunt of a joke or for some other dramaturgic tactic. In the "top 10" lists below I try to emphasize leading or prominent supporting roles and restrict the range to English language films. I offer my 'best' list with the top portrayal ranked first, and the ‘worst’ list with the worst portrayal ranked highest. My worst list (maybe ‘inept’ or ‘inauthentic’ are better terms) is probably weaker, as I try to avoid films with negative portrayals.

The Best

1. Dr. Fried (Bibi Andersson), I Never Promised You a Rose Garden (1977). Docudrama in which the great Swedish actress gives a stellar fictional portrayal of the famous Dr. Frieda Fromm-Reichmann, a wise, kind and generous psychoanalyst working with a psychotic adolescent, based on the patient’s autobiography. Dr. Sonia Wick (Vanessa Redgrave), Girl, Interrupted (1999), is another woman psychiatrist working with hospitalized adolescent girls, a story once again based on a real patient's memoir. Dr. Wick is candid, lucid, caring. Had her role been more prominent,rather than a brief cameo, Redgrave's turn would rank right up there with Bibi Andersson’s Dr. Fried.

2.
Dr. Luther (Lee J. Cobb), The Three Faces of Eve (1957). Another docudrama, with a fictionalized portrayal of psychiatrist Corbett Thigpen, who collaborated with his senior associate Dr. Hervey Cleckley to write a book about the treatment of a woman with multiple personalities (dissociative identity disorder). Dr Luther is steady, supportive and respectful; his only transgression is constant cigar smoking.

3.
Dr. Jennifer Melfi (Lorraine Bracco), The Sopranos, first season (1999-2000). The conduct of a psychiatrist is probably scrutinized more closely and wisely in this series than in any other fictional film account, which explains why I'm including a production from television. The first season provided myriad examples of both good work and errors by Dr. Melfi. It’s a marvelous teaching tool. Unfortunately the psychiatric treatment subtext in the series frayed badly in subsequent seasons, but that’s a hazard with any film sequel.

4. Dr. Tyrone Berger (Judd Hirsch), Ordinary People (1980). Hirsch is entirely convincing as he balances emotional support and a probing inquiry in his psychotherapeutic work with an adolescent boy suffering from severe survivor guilt and suicidal depression.

5.
Craig (Morgan Freeman), Clean and Sober (1988). Newer fashions in psychotherapy are well represented here by Freeman’s “tough love” approach as an addiction counselor working with an arrogant businessman who is dependent on alcohol and cocaine. Another realistic portrayal along similar lines is offered by Steve Buscemi as Cornell Shaw, the program director, in the comic sendup of addictions treatment, 28 Days (2000).

6.
Dr. Sean Maguire (Robin Williams), Good Will Hunting (1997). Another "new breed" therapist, Williams’s character, a clinical psychologist, is overly melodramatic and too self-disclosing, but his method of direct, emotionally charged engagement is often employed these days in work with deviant adolescents, prison inmates, and other "tough cases." For his performance in this movie, Williams, to my knowledge, became the only actor ever to be awarded an Oscar for playing the role of a mental health professional.

7.
Dr. Malcolm Crowe (Bruce Willis), The Sixth Sense (1999). Child psychologist Crowe's manner - his quiet wisdom, gentleness and warmth - with his young client is exemplary. This positive portrayal would, I think, shine through for most lay viewers, even though Dr. Crowe is, technically speaking, a ghost in this story of the paranormal.

8. Dr. Kik (Leo Genn), The Snake Pit (1948). An exemplary early depiction of a kind, supportive and effective public hospital-based psychiatrist, played by the British actor Leo Genn. Though the film is nearly 60 years old, Dr. Kik's blending of small amounts of a physical treatment (ECT) with psychodynamic psychotherapy to treat a woman with a reactive psychosis is a thoroughly modern synergistic strategy.

9. Dr. Jaquith (Claude Rains), Now, Voyager (1942). Like Dr. Kik, Dr. Jaquith treats privately hospitalized patients principally with psychotherapy, in another positive early film portrayal of a psychiatrist at work. Rains’s gentle, steady, supportive approach is well attuned to the needs of his patient, a repressed woman who has been brutalized by a domineering mother all her life. Yet another fairly early positive portrayal of a hospital psychiatrist in a private setting is Dr. Swinford (Howard Da Silva), in David & Lisa (1962). Swinford is accessible, emotionally calm and caring as a psychiatrist working with highly disturbed hospitalized adolescents. Yet another highly positive yet realistic portayal of a hospital-based psychiatrist is given by Caroline Kava as Dr. Blackwell, whose sensitivity and clinical acumen turn life around for the famed Marie Balter, in Nobody's Child (1986), an excellent made-for-TV dramatization of Balter's rescue from what would likely have been lifelong insitutionalization for an illness she did not have.

10. Lisa Metzger (Meryl Streep), Prime (2005). Metzger, a master's prepared clinical social worker, is typical of many therapists that use a model of "good mothering" - warm support, positive regard, hugs and cheerleading - in the therapy of women (and men sometimes) who are needy for such "parenting." Her office is also typical: more like a homey parlor than a professional office. You expect a plate of fruit on the side table.

The Worst

1. Dr. Martin Dysart (Richard Burton), Equus (1977). Like the maverick British psychoanalyst, Ronald Laing, whose views attracted a following in the late 60s, Burton's psychiatrist believes that psychosis is a rational response to living in an insane world. Drs. Dysart and Laing politicize and romanticize psychopathology. More worrisome is the fact that Dr. Dysart is entirely self-centered. Supposedly an expert with young patients, he makes every sort of blunder: he is asleep in his office when a patient arrives for his first appointment, is emotionally volatile and unpredictable (once in anger he skips a scheduled session with the patient), and uses hypnosis and placebo drugs without informed consent. He portrays the most egregious conduct imaginable for a psychiatrist, short of overt seduction or aggression.

2.
Dr. Constance Petersen (Ingrid Bergman), Spellbound (1945). Speaking of seduction, Ms. Bergman rates a tie for first on my 'worst' list, because she set the time honored precedent for filmic female psychiatrists hopping into bed with their male patients. Alfred Hitchcock didn’t want a psychoanalytic subtext for this movie, but his boss, David O. Selznick, fresh from a whirlwind 6 month analysis with Dr. May Romm, insisted on it, bringing in Dr. Romm as a consultant for the film. In the same tradition of female seductress therapists, we have, among many others, Dr. Susan Lowenstein (Barbra Streisand) in Prince of Tides (1991), and Dr. Elizabeth “Libbie” Bowen (Lena Olin), in Mr. Jones (1993). Dr. Bowen begins to act out her countertransference passions from the getgo with her manic patient.

3. Dr. Saul Benjamin (Dudley Moore), Lovesick (1983). Men can also get in on the seduction act, as we see here, when Moore's psychoanalyst falls for a young woman patient and consults a senior colleague about the problem only after having sex with her. Dr. Benjamin's gaffes also include teasing a suicidal patient while intoxicated on call, and cancelling appointments on the spot. No one could consider his over-the-top antics anything but farce, an important issue to avoid the scent of anti-psychiatry. John Huston (as the sage older analyst) and Alec Guinness (as a playful ghost of Freud) enrich this outrageously amusing sendup of analysis and analysts.

4. Dr. Gideon Largeman (Ian Holm), Garden State (2004). Dr. Largeman makes the most wanted list for treating his own son from childhood through adolescence with constant daily doses of psychiatric medications for a non-existent mood disorder, in order to suppress emotional communication in the family after his wife dies.

5.
Dr. Margaret Ford (Lindsay Crouse), House of Games (1987). Even though she’s young, psychiatrist Ford is feeling burdened by her practice and yearns for release, for some excitement in her life. Boy, does she find it, when a gangster initiates her into the world of con games and violence, a world she takes to with gusto.

6.
Dr. Martha Livingston (Jane Fonda), Agnes of God (1985). Dispatched by a judge to unravel a mysterious death at a convent, Miss Fonda is entirely disappointing in her unskillful, indifferent efforts to aid a disturbed novice.

7.
Dr. Leo Marvin (Richard Dreyfuss), What About Bob? (1991). Bob (Bill Murray) is the patient from Hell, an annoyingly dependent, intrusive new client who follows his therapist off on vacation. But he meets his horrid match in Dr. Marvin, a vainglorious fellow who's far more interested in promoting his books than helping others. Dreyfuss does pompous, indignant rage with great skill, but mainly his Dr. Marvin is just a jerk.

8.
Dr. Jerome Davenport (Denzel Washington), Antwone Fisher (2002). Washington’s psychiatrist plays it far too fast and loose with boundaries and roles, especially given the setting of active duty in the Navy for his surly, acting out patient and himself. He’s more like a petulant but caring relative than a professional at work.

9.
Dr. Crumble (Kurtwood Smith) and Dr. Potts (Jeffrey Tambor), Girl, Interrupted (1999). Here are two more cameo psychiatrist roles - both bad - from the same film as Dr. Wick (see "The Best," number 1, above). It’s hard to say which of these two bumblers is the more inept; neither has a clue about working with adolescents.

10.
Dr. Jack Mickler (Marlon Brando), Don Juan de Marco (1995). Dr. Mickler, is a sad sack on the verge of retirement until a manicky young patient (Johnny Depp) begins to kindle a fire in the older man’s belly. The lesson for viewers here, unfortunately, seems to be that it is fair game for the psychiatrist to let the fulfillment of his own needs supercede his patient’s, throwing the usual professional boundaries to the winds in the process. Another recent role in which the psychiatrist’s personal issues eclipse other considerations is Dylan Baker’s turn as Dr. Bill Maplewood, a therapist with pedophilic leanings in the film Happiness (1998).

"Shrink meets patient" is such a popular film theme that we can all be assured of more candidates for both of these lists in the near future.

No Direction Home - Bob Dylan, Martin Scorsese’s new 3½ hour documentary tribute to the iconic pop musician, affords an opportunity to reconsider the early Dylan. Although it required that Scorsese rely heavily on archival material, he wisely chose to focus his film on the most fecund period of Dylan’s long career, from 1961 to 1966, between his 20th and 25th years, when he earned a permanent place in the history of American popular music.

Like many others endowed with creative genius, by his mid-20s Dylan had done his best work. He had created an original synthesis of folk, blues, country and rock idioms. He had written scores of outstanding songs. A middling tunesmith (he has never learned to read music) but brilliant lyricist, he produced, in many instances, lines that are to this day stunning, raw, almost lacerating in their poetic power. His bardic performances were stylistically unique; he brought his poems to life with his trademark flat, oddly nasal, unmelodic talking twang and diffident, sometimes imperious, manner. On stage, he was as cool as Miles Davis, whom Dylan admires.

There was also the almost transcendental phenomenon that Allen Ginsberg describes in this film, wherein Dylan seemed in those early days to be a conduit through which the pent up libertarian yearnings and frustrations of those times – Dylan’s and Ginsberg’s generations - poured forth, channeled with a fresh and urgent voice. That was what set Dylan apart; that was what made his reputation.

Source Materials

The emergence of Dylan’s talent and celebrity are amply demonstrated by Scorsese, who uses old footage and newer interviews – with Dylan and many others - to give us a clear sense of the tumultuous times in early 1960s America, as well as a broad sampling of the musicians who influenced Dylan, from Odetta to Hank Williams, The Carter Family, Muddy Waters, Bobby Vee, and, of course, Woody Guthrie.

Scorsese also had access to D.A. Pennebaker’s film of Dylan’s tours in 1965 (for the 1967 film, Don’t Look Back) and 1966, and footage from Murray Lerner’s 1967 film, Festival, that covered the Newport Folk Festivals of 1963 through 1966. In 1963 and 64, we hear the acoustic Dylan and feel the adulation of the folkies who saw in him someone who might carry on the political protest musical tradition established by Pete Seeger and so many others before him.

Then, at Newport in 1965, we get the notorious scenes of Dylan alienating the crowd with his 15 minute raucous electric set of non-protest songs, backed by the Paul Butterfield Blues Band. On tour subsequently in Britain and around the US, we hear the boos and jeers from crowds who perceived him as a traitor to the counterculture protest movement.

Curiously, Ramblin’ Jack Elliott is absent here. In the 2000 film, Ballad of Ramblin’ Jack, made by Elliott’s daughter Aiyana, the Elliotts claimed that Jack introduced Dylan to Woody Guthrie’s music, and Arlo Guthrie, also absent from Scorsese’s film, agreed. Other omissions include references to Dylan’s drug use, and the fact that not long after JFK’s assassination Dylan said that he identified with Lee Harvey Oswald, though we do see footage from the occasion when he said this. One gets the sense that the Dylan profiled in this film has been airbrushed some, which is why I think the term “tribute” is a fair description.

The interviews with Dylan made for this film are problematic. They were conducted by Dylan’s own agent, Jeff Rosen, neither a practiced nor an impartial interviewer, and were completed even before Scorsese joined the filmmaking project. Dylan seems thoughtful and earnest enough, but often bland and sometimes slow off the blocks, perhaps insufficiently challenged by an overly sympathetic host. Dylan maintains, as he always has, that his motivation to write songs in the early 60s was his intense desire to perform music. “I wrote because I wanted to sing."

Scorsese doesn’t showcase Dylan’s own work as well as he might have done, and the reason is hamhanded editing of Dylan’s songs. It is egregious in a documentary about any musician to repeatedly interrupt songs midway though in favor of some talking head. Numbers like “Don’t Think Twice, It’s All Right,” “A Hard Rain’s A-Gonna Fall,” With God on Our Side,” “Like a Rolling Stone,” and “Blowin in the Wind” are routinely cut off after a minute or so. There are several obvious ways in which this could have been avoided.

The Dylan Mystique

For years it has been customary to describe Dylan as enigmatic, mysterious, contradictory. Early on such impressions became fixed in the media and in many of our minds, where they have remained, unmodified, over the ensuing four decades, abetted by Dylan’s own reclusiveness since the mid 60s, to be sure. So, does this film help dispel the Dylan mystique?

Watching No Direction Home I thought about the incalculable stresses to which Dylan surely was exposed as a youngster early in his career. He had stupendous talent, and, as so often occurs with persons of magical celebrity, everyone wanted a piece of him. Ginsberg wanted to hand him the Beat baton; Seeger, the folkies protest banner. The youth counterculture regarded him as a spokesman for their declarations of freedom. Some black leaders perhaps saw him as a useful, racially enlightened white. Journalists alternatively scorned him or regarded him as a savant, but either way, they tracked him like bloodhounds.

Dylan’s songs may have conveyed a sense of weltschmerz, of a deep wisdom beyond his years; and his poetry often did seem to speak for others, old and young. But he was at the same time a wet-behind-the-ears kid from Hibbing, for Heaven’s sake, who had spurned his roots and family and at 21 was living hand to mouth playing harmonica in the Big Apple. True, he didn’t act the innocent: he radiated whip smart street sense and had a capacity for self reinvention, for role playing and creating false stories about himself, that bordered on the psychopathic.

Because of his songs and his manner, many people regarded Dylan as more mature, more in control, more self aware, than he was, and they measured his conduct and decisions by a standard that would be tough to meet for the many older, more settled individuals. These same people were at first incredulous, then sorely disappointed, finally outraged, when, instead of social ideals as a guiding light, Dylan began to live out (and sing about) highly personal strivings of the sort often evident in smart contemporary kids.

Kid Stuff

Dylan could be self aggrandizing. Opportunistic. Full of swagger. Rude. Callous toward women. An insulting tease to journalists (though just as often they insulted him…one asks in the film how many protest songs exist; Dylan shoots back, “142.” When challenged, he wryly revises the number to 136.) What’s worse, for those who idealized him, he rejected being categorized or adopted as the new leader of any social or political movement.

In this light, some of his gestures – for example, touring the south with Seeger and playing at the 1963 Lincoln Memorial gathering where Martin Luther King Jr. delivered his “I’ve Got a Dream” speech – have always remained difficult to interpret. Was he being disingenuous? Inconsistent? Self promoting? Why not all of these? I think he was being a kid - a youngster whose personality was still not fully formed - under constant, enormous psychic pressure. Finding his way by trial and error. Understandably erratic.

Dylan claimed that all his songs were protest songs, and I believe they were, the protests of a rebellious youth. Get off my back, go hitch your wagon to some other star, his lyrics and deportment kept announcing. He said over and over again that his goal was simply to make music, to follow his muse (“Mr. Tambourine Man”). And if that’s not acceptable, stick it in your ear (“It Ain’t Me Babe,” “Maggie’s Farm”).

He had a postmodern kid’s ironic, cynical outlook that nearly everybody was a cog in some vast “system” and thus simultaneously someone to be distrusted, a victim of circumstance, and a possible catalyst to assist his own advancement. That is how he could write the lyrics about Medgar Evers’ assassin (“He’s Only a Pawn in Their Game”) and identify with Oswald. These stances fit into a kid’s conspiratorial worldview.

Prodigious talent like Dylan’s is intrinsically mysterious, never reducible to psychological terms. But his youthful rebelliousness was in step with his times, and this fortuitous circumstance was central to the flourishing of his talent. The psychological costs, however, had been high. His motorcycle accident in mid-1966, the event that marked the end of his most creative period, was a wake up call. In a 1985 interview for Spin magazine, he said that the accident forced him to realize that (far from being a cool, self-possessed young man) he had reached the point where he lacked “any kind of perspective,” could not have sustained his “wound up” pace much longer, and “probably would have died” if he had tried.

After the accident he withdrew from public appearances for 18 months. Six months after that, according to biographer Robert Shelton (“No Direction Home: The Life and Music of Bob Dylan,” New York, Beech Tree Books, 1986), when Dylan attended his father’s funeral in Hibbing, his younger brother David described him as having a “quietude, firmness and serenity befitting a fifty-year-old man.” By then, we might infer, the kid had walked down enough roads that we can call him a man.